Wherein a surgeon tells some stories, shares some thoughts, and occasionally shoots off his mouth. Like a surgeon.

Thursday, January 17, 2008

Flush

It's gratifying that despite my absent posting for many weeks, this blog still gets over five hundred visits and more than a thousand page views daily. This I attribute to the fact that some of my stuff comes up on searches for medical information, which makes me feel as if, whether or not I regain my enthusiasm for bloggery, my work will have been of use. (Or maybe it's just that people like coming by when I'm not around so they don't have to worry about running into me.) Anyhow, I still get comments and questions; quite frequently on the subject of gallstones, about which I wrote a series (one, two, three, four) of posts many months ago. A recent visitor asked some good questions about non-operative management of gallstones, and I was surprised and disappointed to discover that I hadn't really covered it in my prior series. So this is an attempt to rectify (a term which I used in a punny context -- and one which gets hits now and again, from the perverted and/or the easily amused, ever since -- here, and here.)

Let's start with a gentle statement of fact: OF ALL THE BOGUS, DISHONEST, DISINGENUOUS AND STUPID BULLSHIT THAT MASQUERADES AS ALTERNATIVE MEDICAL METHODOLOGY, "GALLBLADDER FLUSH" IS AT THE TOP OF THE LIST. THE PURVEYORS OF IT ARE, AT BEST, CREDULOUS; AT WORST, THEY ARE CHARLATANS AND (LITERAL) SNAKE-OIL SALESMEN WHO WILLFULLY DECEIVE AND STEAL FROM THE SICK AND THE VULNERABLE, AND ARE TO BE COUNTED AMONG THE SCUM OF THE EARTH.

OK, let me tell you what I really feel.

Over the years, particularly after the dawn of that series of tubes called the internet, patients have asked me about "gallbladder flush" as a method of eliminating gallstones. They've handed me recipes (which commonly include some sort of oil and something acidic like lemon-juice, with a few plants thrown in), and, in some cases, have proudly presented me with little cartons of their stool, containing what they are certain are stones they have pooped out as a result of drinking their herbalicious and natural remedies. Fortunately, as a surgeon, I'm well-used to staring at excrement in its many forms, both within and without the confines of the viscera generally expected to contain it. What I saw was curds. I know stones, and I know curds. These was curds, is what they was. Evidently, if you drink some kinds of oils and chase it with certain acidic substances, what you get is curds in your turds. What you don't get -- and trust me, I've seen the proof in pre- and post-glugging ultrasounds -- is change one in the number and nature of stones in your gallbladder.

As with most other forms of medical woo, the pharaohs of phlushes toss around terms like "toxins", and "weak liver," and "detoxify." They make extravagant claims with no proof. Potions of prevention, like methods to keep the elephants away, are hard to disprove. If my writings over the past couple of years confer me with any credibility at all, please trust me: it simply doesn't work, and the proof -- when there actually are stones -- is easy to obtain. If you really believe it, do it. And then get another ultrasound.

There are, of course, those who push these flushes onto the healthy, onto those with no gallbladder problems at all. Generally those are the ones who have something to sell, and, sad to say, they easily manage to separate the credulous from their cash. Like chiropractic on healthy kids and homeopathy on anyone, it most often does no harm, other than to one's economic well-being, and in the situations wherein it delays needed and actual treatment.

A truism: people who produce the kind of bile that can precipitate crystals will, as long as they have a gallbladder (which is where the crystalization occurs), form gallstones. A corollary: treatments that eliminate stones but retain the gallbladder are generally followed by the return of the stones.

Indeed there are pills that can dissolve gallstones. I've prescribed them, for people who really, really want to try everything to avoid surgery, or for people in whom I've thought the surgery would not be tolerated. The main problems are with side-effects (nausea, cramps, diarrhea typically), and the fact that success depends on the nature of the stones (big ones are unlikely to dissolve, as are ones that contain calcium), as well as the tendency for stones to come back again, eventually. Also, it takes months for the stones to dissolve. But since -- as opposed to flushes -- they may work, such pills are an option, and should be part of the discussion for people facing surgery.

You can also smash gallstones. Twenty years ago, extra-corporeal shockwave lithotripsy (ESWL) got a fair hearing, if for no other reason than it was cool to say the phrase. Results have been predictably disappointing. (My hospital contracted a privately owned, trailer-borne machine to occupy the physicians' parking lot once or twice a month, into which the gallstone-bearing were rolled and pounded. I was told -- by the owners, not the hospital -- I could accompany my patients into the unit and sit there while the technicians did all the aiming and calibrating, and then I could push a button and charge a grand or so. I demurred.) Similarly, you can guide a catheter directly into a gallbladder and irrigate with a form of ether which, in addition to giving you weird breath for a while, has a chance of dissolving stones comparatively instantly. Long-term, the results are as expected. Short-term, there may be the really rare situation in which it could make sense.

Of all the things a person can do to live non-operatively with gallstones, dietary changes make the most sense. Typically, gallbladder attacks happen after eating a fatty meal, so, theoretically, modifying one's diet to avoid fat and any other personal triggers makes sense. Theoretically. In some people it's a very linear relationship: eat fat, have attack. Don't eat fat, don't have attack. But for many, the attacks come in no relation to eating. On the other hand, by far the majority of people with gallstones who have symptoms (NB: not everyone with stones has problems from them. I was among those surgeons who leaned away from operating in the absence of symptoms) don't go on to have the really serious complications that can occur with gallstones. So for the average person, absent risk factors that could make complications more serious were they to occur (diabetes being high on the list), and absent a crystal ball, trying to live without surgery by judicious dietary behavior -- and, for some, trying pills -- is not entirely unsensible. Just, in the name of all that's holy -- or unholy, if you prefer -- don't waste your time, or your money, or your self-respect, on flushes. Really. It's the poster-child, the sine qua non, the Platonic ideal, the Mona Lisa of quack.

This is embarrassing, but since you brought the subject up and I am anonymous. I’m no stranger to the more than occasional fatty meal, but I finally figured out that my gallbladder “attacks” always came after (1) eating after having gone a long period of time of not eating (e.g, too busy to eat; and the first food eaten didn’t have to be a meal, it could just be a handful of grapes); (2) eating an unpeeled apple; or (3) eating anything with lemon juice in it (greek salad dressing was the worst).

I don’t believe for a minute that the flushes would work, but in the back of my mind, I’ve always wondered about this. Was the lemon juice just a personal trigger, or could there be some relationship between the gallstones and the lemon juice? (and if you respond, be gentle, I am a layperson. A very non-scientific type layperson).

The first issue, of course, is to what extent you know your problem relates to your gallbladder; ie, do you know you have stones... Assuming you do, then, because the gallbladder contracts to some degree no matter what you eat (more so with fats, but not exclusively at all), and because it contracts periodically on its own regardless of eating, any food -- or no food -- could be a "trigger." If it indeed is lemon juice, that would still not have any relationship to the idea of a "flush." I didn't go into the reasons why there's no physiologic sense to the concept; in brief, the idea that any intake would "flush" stones out of the gallbladder is bogus on its face, based on the anatomy of the gallbladder -- ie, the size of its opening vs the size of stones. It is indeed true that stones can pass from the gallbladder; generally quite small ones. And when they do, all hell can break loose: excruciating pain, pancreatitis, jaundice. It's fortunately rare, compared to the number of people (millions) who have gallstones. However you might want to rid yourself of stones, flushing -- if it were even possible -- would NOT be the way you'd want to do it. The gooey curds that I've seen after "flushes" are in no way similar to the hard little (and big) nuggets that are gallstones.

Assuming you have stones, it's entirely possible that any particular food could trigger attacks. But it has no predictive value of whether a flush would work, other than to say that it wouldn't, no matter what.

oh, I am happy to read a new post from you! But, I do have a question about gallstones. What is it that makes a person who has stones go from years of being asymptomatic, to symptomatic, in about one days time?

I first found out I had gall stones in 95 at a time when I was having many scans done because I had recently been diagnosed with cancer. my Docs all told me "You have alot of gallstones" but, since they were not bothering me and to many other things were, we just ignored them. It would be 8 years later in 2003 before I had my first GB attack. And it was a dandy. then, they kept right on happening, almost daily, for several weeks until my general surgeon hanked the thing out. he told me it looked like an M&M factory in there. I have always wondered why I did not have symptoms for so long and then when I did they would not stop. I had not changed eating habits, but I was also having alot of reflux problems. Connection between GB problems and reflux?

cathy: far as I know, there's no known reason why stones become "active" after being asymptomatic. Nor can I think of a connection between reflux and gallbladder activity; the opposite could be true, however. Sometimes it seems gallbladder inflammation slows gastric emptying, which could, in turn, increase reflux. I suppose there could be another process that would affect both gallbladder function and gastric emptying.

I've had only 2 "attacks" after my gall bladder was removed, one involved real mexican food (probably contained lard) and the other (you'll love this) was after my son was born, preemie, I had to pump "the girls". I ended up getting this hellish UTI and the the "girls" refused to be pumped further. Thus the "girls" got ENOURMOUS and hard as can be, thus the gall bladder attack (without the gall bladder) happened, exactly like I had had, before it was removed. Went to the ER, they thought I was in so much pain because of kidney stones, and I'm sure got a laugh that I was having a classic gall stone attack (as in felt like a heart attack, elephant sitting on the chest and slowly radiating out), without one from my damn boobs. They pumped me full or morphine, hoistered the "girls" up with a huge ace bandage and It stopped. I figured they were so huge and hard they were pressing on some vital organs and causing the same pain, but that was just a guess. I'd love to hear your take on it.

SS: since the pain went away as soon as the ladies (I think if they're that full, they're no longer girls) were hoisted, it seems the pain wasn't related to your innards.

The general problem of pain which seems like a gallbladder attack, after gallbladder removal, is happily not real common, but can be a tough one when it occurs. It raises whether the pain that led to the gallbladder removal was from something else; or if there's a retained stone somewhere in the biliary system. As I mentioned in one of my posts in the gallbladder series (they're listed in the post below this one, called "Sampler), there's also the iffy condition known as "cystic duct syndrome," which is gallbladder-like pain that occurs after removal when the cystic duct (the tube between the gallbladder and the main bile duct) was left too long. It's controversial whether it's a real entity. If it is, it ought to be more common now than it was years ago, because it's more common to leave that duct long during laparoscopic surgery than it was/is with open surgery.

Glad to see you're back writing again... Stories about gallbladders always make me think about my friend's tangle with a lap chole a couple of years ago, and the complete difference it was from my aunt's open cholecystectomy about 25 years ago. My friend said she had to make a few modifications in her diet after the surgery, since too much fat in one sitting causes some problems. Apparently that's not uncommon, but it's not universal. Fortunately I still have a gallbladder, and I plan on retaining it. Do you know what makes gallbladder problems more common in women? Just curious what your experience has to say about that.

I'm grateful for your blog (and the book!). As a lay person, I learn so much here.

About 25 years ago I decided to go on a totally fat-free diet and did, and it wasn't easy, LOL! What doesn't have fat in it? But after two weeks of that I woke in the middle of the night in excruciating pain in the belly, so bad I was unable to get to the phone to call an ambulance. I resigned myself to death. It was that bad (and I'd had seven kids). At some point I passed out, woke the next morning feeling just fine, as though nothing had happened. I decided it was the fat-free diet and gradually added fats back into my diet. I love fat, love bacon, don't like meat unless it's fatty, etc. And have never ever had such an experience again. No belly problems at all. I've never mentioned this to a doctor. Almost never see one because I enjoy perfect health (age 68) and I do mean perfect. I've always assumed the attack was probably a fat-deprived gall bladder, maybe just a personal quirk. Is such a thing possible?

It would seem that, if one could actually "flush" the gallbladder, it would likely end up as an unpleasant and acute abdominal problem needing surgery once you blocked off the duct.Kind of like the idea of "flushing" the plaque from your carotid arteries -- maybe you don't really want to do that.

I have been reading your posts for the past few months. I currently study Biomedical Sciences at university in the UK but hope to study medicine in the future. I have to say your posts have been an absolute inspiration in no uncertain terms. I have really enjoyed every one of them and I have found myself reading them during many a dark hour while studying yet another biochemistry/molecular biology/microbiology textbook for inspiration.

I had a miserable year after the birth of my second child in which I tried to avoid having surgery for the gallstones which formed and passed (quite painfully) from my gallbladder. My grandmother finally set me straight. She told me that the surgery (pre-laparoscopy) would be far less painful than the episodes I was having.

She was right. I haven't missed that pesky gallbladder one bit. It's been over 20 years now.

Dr. Schwab, I have a question for you - Speaking of calcium deposits and such - What are the benign bumps that some people get (seems to be on arms and lower backs) that are very superficial? They are not tumors, abscesses, or cysts - are they just calcium deposits too? I have no idea how to look this up, but I'm curious.

Yo, Sid, one of the reasons for those hits is that your public are addicted to your words, so we keep checking back again and again and again looking for the resumption of your regular doses of wisdom, insight and wit.

Thank you SO much--Having been told today by my gastroenterologist that the likely cause of my symptoms is gallstones, I've been researching online, in advance of a scan that she ordered and a meeting with a surgeon at UCLA. The first several things I found were filled with horrendous stories of people who were much sicker AFTER their surgery than before--plus all the ones that woo you with promises of non-surgical removal via flushes.

While it didn't sound logical (if it hurts SO much to pass a stone, how can it be 'painless' to 'flush' them out?), when you're looking for reasons NOT to have surgery, well, you start suspending disbelief.

Then, thankfully, I discovered your blog--and have read through your entire GallBladder series--I feel much less afraid of the possibility of surgery now, and a lot more intelligently (not to mention poetically) informed. THANK YOU!!!!

I kind of get the impression from reading your posts that you're not a fan of the laparascopic method--should I avoid that, despite the shorter "down time?"

I'm generally in good health--though I have been diagnosed, based on ANA tests, arthritic symptoms, and sun sensitivity as having lupus--I have never had, thankfully, any organ involvement. Would having an autoimmune disease affect a decision in terms of laparascopic vs open surgery?

Diana: thanks. Glad to be useful. And, no, I'm not at all opposed to lap chole. It's clearly become the procedure of choice and it's a very good operation. I happened to have developed, even before lap chole was around, a way to remove a gallbladder through a single very small incision, and I continued to do it (I learned lap chole, and found it fun to do.) There's practically no one doing it my way -- at least not with as small an incision. My way saved a lot of money, and it sort of became my "thing." Have a lap chole and be happy about it!

Hi! I just stumbled across your posts and thought I might add one of my own. I've suffered (seriously, I've really suffered) gall bladder attacks for a little over a year and half now. I had my daughter in March of 06 and by June of 06 I was on my knees begging for someone to shoot me because of a gall bladder attack. I went to the doctor and he told me it was my gall bladder. Nearly all the women in my family (and some of the males as well) have had gall bladder issues and have had it removed. I'm anti surgery altogether and mostly because I'm the biggest chicken in the world not to mention a hypochondriac and always assume I'm dying of some new illness. I boycotted surgery this whole time and as time went on I began feeling new pain. I changed my diet completely. I quit eating a lot of fats and if I did eat them it was like a half a cup of Uncle Ben's minute rice which contains 2% fat or something like that. I added fruits and a little vegetables to my diet as well. I lost 97 pounds from all of this. However, since I began my diet my pain has become strange. I still get the occasional gall bladder attack (3 in the last 2 and a half months) but when I'm not having an attack my whole stomach feels as if it's on fire. Note that this doesn't happen everyday but I'd say a good 3 times a week. I asked my doctor what this was and he seems to think that it's related to my gall bladder or an ulcer. He also told me I'll get scurvy if I keep up my diet (I only eat steamed rice and apples now). Ah...it's been a rough year and half and I feel like I'm going out of my mind with it all. My teeth have started to decay and fall apart and I hear it's from my diet. My surgeon told me that he wasn't sure if my gall bladder getting removed would even help me. I feel like I'm damned if I do and damned if I don't. I'm not really sure what I'm asking I guess. Maybe some reassurance that having my gall bladder removed will be the best thing. Are my problems even my gall bladder (as far as the stomach burning goes). Perhaps someone with a crystal ball could tell me the future..yeah, that'd be nice. I hardly eat at all anymore and I hurt from that. I had an attack from eating steamed rice a week ago, something that hasn't happened to me before. Usually I'd have an attack after I tried some sort of fat. It actually occurred about an hour after eating. If I eat fats I usually won't have an attack until 6-8 hours after I've eaten. I need some help. If you're able to provide any I would be so happy! Also, since I've made such a drastic change to my diet, is it even possible for me to ever eat normal again? I'm freaked out!

jade: I'm pretty sure if I'd been your surgeon back at the start of this, I'd have been very positive about the benefits of surgery (you didn't describe the pain in detail, but assuming it was consistent with gallbladder origin -- pain that severe is certainly common). If your surgeon is reluctant now, it may well be because of the damage you describe, which it seems you've done to yourself, and I can understand reluctance to intervene until you're in better health. I can't make a prediction or a recommendation because I don't know you. If you've read my other posts on the gallbladder, you know that I consider surgery, under the proper circumstances, to be safe and effective and, for most, generally free of significant side effects. The decision of when and if has to be between you and your doctors. It sounds as if you'll need their help to get both into physical and emotional shape again.

hey doc - so glad i found this blog, wish i had found it sooner! just had lap chol 4 days ago. RUQ U/S and CT scan both confirmed 2 stones ~2cm (plus a probably harmless liver cyst), and i was having early satiety and such symptoms, but only one small incident as painful and critical as seems to make surgery a no-brainer. i do wonder now why i didn't get some of the diagnostic tests described before the docs put me on the fast track (no HIDA, no CCK) ... too late now for me, but i'd like to know more before any of my sibs may face a similar decision.

i found this site by searching for info on gb surgery recovery. didn't find much out there other than this site and forums - any resources you can recommend are welcome.

anyway, i'm still having a lot of abd/chest/back pain and darker/bloody urine. i am wondering if this is typical, or did i overdo, or maybe could it be due to the liver biopsy they did while in there? i didn't have blood in my urine before, was checked ~1 wk ago, but that box wasn't checked on my discharge papers as something to call the docs about.

anonymous: you should definitely let your surgeon know about the blood in the urine. It might not be blood, either: it could represent bile in the urine, or even just dehydration causing the color. But it's not "typical."

thx for the guidance - i did call my surgeon about the blood. his nurse assures me it's not unusual given that i was catheterized during the surgery (which i was NOT aware would be done, but makes sense), and having the liver biopsy. i don't fully understand why either explains the blood, but the color's normalized somewhat in the last 24 hrs, so i guess it's ok ... i'll ask more pointed questions when i see him next Monday for followup.

i really appreciate your input - it is hard to walk the line between hypochondria and ignoring a symptom that might be important, without knowing what's expected and what's not. thanks again, and please keep writing!

michelle: it's totally routine. In fact, theoretically if one leaves much length of the cystic duct, there can be problems. "Amputated" sounds scary, but all it means is that the cystic duct is removed along with the gallbladder, snipping it off near the main bile duct (the common bile duct), just exactly as it should be.

Thanks so mich for answering my question Dr. Schwab. I have to admit that the term "amputated" did have me worried; I'm glad to find out that everything was just routine.

One more question for you and I promise to stop bugging you. But I won't stop reading your blog, because I love it.

On the pathology report, it said that there was fibrous obliteration of the appendiceal lumen, what does that mean?

Your next book should be about gallbladder surgery; seriously. Because so many people have questions about the procedure, and most with gallbladder problems who face getting a cholecystectomy would benefit from reading it.:)

"lumen" is the inside of a tube. The appendix is a tube, of sorts. "Fibrous obliteration" means it's been scarred down to having no "inside." The implication is that at some time in the past there was inflammation that resulted in scar tissue forming which filled the inside of the appendix. In other words, at some time you had a mild enough case of appendicitis that it didn't get to the point of being noticed or treated, and it left the appendix replaced with scar tissue. That means it probably wouldn't have been a problem again, because with the inside being just fibrous tissue, infection couldn't get in again.

After perusing the "alternative healing approach" wich did include the dreaded "flush" , I found your blog. I had all but convinced myself I could take a bunch of healing herbs(beet pills,enzymes, fat metabolizer, sugar craving help, etc. and forego the dreaded gallbladder surgery. You see I'm terrified. My palms are sweating as I write this. I'm sure I'll either wake up paralyzed or feel everything during the surgery. I've also read too many stories of continued pain and problems. In a nutshell; I've had gallstones for almost 12 years, all of them horribly painful. My last attack really scared me. All I did was move funny on the couch and I was on the floor in familiar but worse writhing pain. I thought it had finally "burst" I was barely able to tell my husband to call 911. BTW I'm 32, mother of 2, 119pounds 5'2. Normal weight for me is 110. At the hospital they confirmed my stones, told me that its infected, and that I have wall thickening. reccs were transfer to a bigger hospital, 2 days iv antibiotics, and then removal. AFter a dose of painmeds and some antibiotics I checked out ama. That was last tuesday, I'm meeting with the surgeon tomorrow. Armed with tube questions and anesthesia fears I'll go to my appointment with a more open mind. There is still no way to keep it huh? What about fixing the cause of it? Not just with diet, you think the enzymes and beet pills can help the liver break down fat better? Minus the quack flush you've got to admit there is convincing evidence other stuff can help. I'm not interested in dissolving anything just want to make the system work better. Maybe lessen my ciggerette like habit of chocolate intake. What a long one. You might not even read this. But I hope I earned your time with 12 years of hellish pain and insensitive docs who would refuse pain meds until I had surgery. With your blog I have found a doc with real smarts, a little heart, and a sense of humor. A diamond in the midst of many rocks. HHahaha. :) Cant wait to buy your book. My best to you.

Jeanna: Actually, I don't admit there's convincing evidence the other stuff works. It doesn't. I sympathize with your fears. Having surgery IS scary. But as a surgeon who's done a couple thousand gallbladder operations, I can say you're exactly the kind of patient I love to see: clear cut stones and symptoms, young, healthy, normal weight. I'd expect it to go extremely well, and would also expect a very happy patient. (No guarantees, as you are aware: still, if ever there were a situation about which to make a pretty confident prediction, you'd be it!) As to side effects, they can happen. But remember: it's about the most common operation there is. You hear the complaints of a very small percentage. In my experience, the vast majority did great and were delighted.

I put off gallbladder surgery way too long myself. My grandmother finally straightened me out. She told me that the surgery would be easier than any one of the episodes I'd had hanging on to that gallbladder.

Just wondering. How long is it safe to put off GB surgery. My mom is 75, in the moderate stage of Alzheimer's and has gallstones stacked up like cannon balls. Her main symptoms are heartburn and hiccups. but because she forgets so quickly, I worry about the recovery period.

anonymous: it's a crystal ball thing. Many people have gallstones with no symptoms and live their whole lives without surgery. Some have a little trouble once in a while, and do fine without surgery. Some who have gallstones can suddenly get very sick. There's not a good way to predict except to say that those who have recurring episodes of "gallbladder attacks" (and hiccups and heartburn might or might not have anything to do with her stones) keep having them and have a higher risk of having more severe complications. When stones are not felt to be causing problems it's often appropriate to do nothing. The decision for an individual needs input from the doctors that know the person.

From your cryptic questions, the answer to the first of which is yes, I infer you think I'm objecting to flushes because they steal money from me. No, actually. Since they don't work, eventually those who need surgery come to me anyway. Meanwhile, the purveyors of flushes steal money from you. I can wait.

I can understand why people would buy into that kind of treatment. Living in a third world country, in medical terms (Canada), I totally understand the desperation and willingness to try anything.

I myself have an appointment with a holistic herb-master next week. Why? Because I've been having gallbladder symptoms for almost a year, and by now the notion of HIDA scans, CT scans and such seem like American fairytales. It takes 3 months to get an ultrasound where I live, another 3 to see Gastroenterologist.

I've been unlucky, because my ultrasound didn't show anything wrong, and the Gastroenterologist I was sent to see was retiring, so he just made sure I wasn't bleeding internally from an ulcer and sent me home. He didn't even ask if I'd had an ultrasound.

I'm going to see my family doctor again next week, and maybe some begging will get me an appointment with a Gastroenterologist that isn't retiring or leaving the province, but I don't want to get my hopes up.

So what is one supposed to do? You'll try anything to stop the pain and feel like a normal person again.

I came upon your wonderful blog, when I searched for any evidence on the net that a gallbladder flush isn't for real. I thought I had stones, when I started to "burp" several times a day. It's not usually the loud belch, but most of the time silent hiccup like movement. After a year of living in sedentary life -working at home and sitting in front of the computer for almost the whole day- I've started to feel weird things in my body. Like, at first I got a really bad neck and left shoulder and back pain, and I could feel small lump at my nape. When I had it checked, the doctor said I had strained myself with the exercise I did, after being sedentary, and that she couldn't find any lumps in my nape and armpits. days after that i could still feel a tiny lump but not as noticeable as before, but my shoulder and back continued to hurt but less than before. So, I went back again, but this time another doctor from the clinic checked me...and she said the same thing about strain and that my lump could be of my tooth cavity. There are times when I couldn't feel the lump and there are times when it's so noticeable. So, my question is, what could be this lump and burps?

This is quite a long one, but I feel like I've become hypochondriac, and I'd really appreciate your incite about this.Thank you so much!-Anna

anna: much as I'd like to, I really am in no position to try to diagnose anything from afar. I try to provide general information, and frequently shoot off my mouth; but I have no way of giving specific advice or diagnosis for a person I don't know. Sorry.

Dr. Schwab:Thank you so much for the very quick reply.I actually feel fine and healthy, but I get bouts of hypochondria from time to time. This is probably a sign from my body to start exercising. Again, Thanks.

I have a question. Do you know how quickly gallbladders can escalate from "Healthy but with stones in" to "mmmm oozing pussy infected"?

I started having (what I assumed to be) acid reflux attacks in late summer starting last year. (I agree with the person who posted earlier, wondering if there's a connection between acid reflux and gallstones. They seem connected in me, at least.) Talked to a doctor, got they agreed with the diagnosis and I set about trying to change my diet to something less offensive to my stomach. Then, at the start of March, I experienced a different kind of attack with what felt like a different type of pain. After talking to a doctor, I went and got an ultrasound. Not long after, the results came back, showing I did indeed have gallstones. However, the ultrasound showed that while there were stones, everything else was healthy. No thickening of the walls, not that many stones either.

Since I'm against removing organs, I decided to enact change through diet, health, and yes, some of those more 'natural' remedies.

The problem is, things are getting worse in the gallbladder area. The attacks came and went, but recently have gotten a lot worse. Over the past five days, I've had three not small attacks (only one of which I can link to my food.)

I'm resigning myself to the idea that I'm probably going to have to get the gallbladder cut out, but I was wondering how quickly gallbladder problems can escalate. My attacks have relatively little nausea, pain comes and goes, no jaundice, but seem to last for a while. I've got some a busy May planned, so I don't want to dump a surgery in the middle of that to mess it up. On the other hand, I don't want to put myself in danger by putting it off.

lunarflight: I don't want to give specific advice for any particular situation. But I can say what I told my patients when they asked similar questions. It's rare to go from no problems with gallstones to really dangerous ones without having a few "warning" attacks first. So for many people who have stones and zero symptoms, waiting to see what happens may be a reasonable choice. (There exceptions; plus, it's sometimes hard to say when atypical symptoms, such as "reflux" are really from the gallbladder.) In people who have symptoms, the chances of going on to more severe problems are significant. No one can say, for a given individual, what the future holds. As to how long it takes: any amount of time. All that needs to happen is for a stone to pass and get stuck in the main bile duct (depending on size), or to get solidly lodged in the outlet of the gallbladder. Could happen one second from now; a week; ten years; or never.

Thank you for writing this blog and for responding to all the comments! I wish I had found it long ago.

I was one of those people waiting to see if I REALLY needed to have my gallbladder out, despite having massively painful attacks several times weekly. To anyone else wondering about this, I would say DO IT. I starting having attacks in Jan '04, and by June I was seriously popping Vicodin, no matter what I ate. In the middle of June, I had a really bad attack that sent me to the ER, but the ER waiting room was so terrible that after 4 hours I just left. Three days later I was turning yellow, and back to the ER I went (at a different hospital.) I was admitted and waited 2 days before having the first of two procedures (one to cut the muscle of the bile duct and the other to have the gallbladder out). The surgeons kept having even more serious emergencies to attend first. I really regretted not having scheduled the surgery myself months before when my doctor told me the first time. I could have been in outpatient surgery without the serious complication of a bile blockage. Instead I spent 5 days in the hospital feeling even more miserable and getting an infection in my arm from the IV being in one place too long.

I want to reiterate for others looking for help that sometimes it really doesn't matter what you eat. I had just lost 35 pounds and was on a very low fat diet. Good luck to everyone else dealing with this, and there are some really great surgeons out there!

You are amazing. A surgeon that is willing to develop a blog such as this that is beyond helpful to anyone that comes across it.

I had my gallbladder removed yesterday (a little less than 24 hours ago). I have read your gallbladder series front to back.

I am wondering ... I have the typical pain in my right shoulder which I presume is from the gas used to create room to move in my stomach. (I experienced this years ago when I had my tubes tied.)

Have you come across a situation where the patient also goes numb in his or her fingers (the ring and pinky fingers) and hand, and possibly the bottom of the arm? Is it likely that this is from the gas possibly pressing on a nerve?

I have my follow-up appointment with the surgeon on Monday and will address this if the issue remains. In the meantime, it would be awesome if I could hear your opinion.

Heidi B: you are correct about the gas that's used during surgery causing shoulder pain after. As to the numbness you feel, that's a different problem. You describe dysfunction of the ulnar nerve, and it can happen with surgery when the arm is positioned or padded improperly. It's something we try like crazy to avoid. It ought to go away with time, but you should definitely tell your surgeon about it, so feedback can be given to those who positioned you during the operation.

Hi - it is me again (Heidi). Thank you very much for your excellent explanation of why my fingers were numb. You are correct, this went away within a few days.

I am now 10 days beyond laparoscopic surgery. I had my follow up appointment & the stitches are removed. I returned to work 6 days after surgery.

Can you explain why some people have discomfort under the right rib after surgery? The incisions are healing beautifully and there is not much discomfort with them at all. However, just under and beneath the right rib (inside not outside), I have discomfort most of the time. The pain increases greatly when I cough. This is the same area that hurt when I woke up in recovery. Please note that this pain was not prevelent at the follow up appointment when I had my stitches removed.

I find that I tend to clutch this area with my hand frequently. I will, of course, follow up with either the surgeon or my general physician if it continues or gets worse. I am simply curious why I have pain inside now that the gallbladder is no longer there.

Heidi: I really can't say. I'd assume it has something to do with your surgery itself: injury to muscle, etc., that will go away in time. But since I can't tell exactly where, or what it is from over here, it's something to address to your surgeon.

I was so glad to find your blog! My parents have been trying to convince me I need to do a gallbladder flush, even though I don't have any stones (from an ultrasound) and a bile sample during an upper GI didn't even find crystals. I keep telling them there's nothing to flush! Anyway, I've been having some gallbladder disease-like symptoms off and on for a few years, but after I weaned my son from breast feeding I started getting chronically nauseous. At first it was just with PMS when my cycle returned, but then the length of time got longer each month until I was nauseous for two straight months, and started getting indigestion, too. My digestive disease doc did an upper GI and said I had gastroparesis and mild irritation to the lining of my stomach, though he didn't give me a reason why this would happen to me all of a sudden. (I'm 29.) He put me on a med for the gastroparesis that I took for 2 months. It kind of helped, but not completely. I DID at least start feeling hungry again. I was convinced my stomach problems had to do with my back (I have an insanely tight muscle and curve in my spine right behind my stomach) so I started taking yoga, and that actually seemed to help...until I started having pain in and under my right rib cage, that felt like my ribs were out of place and the muscles were pulled tight over them. After two months of this, I went to a chiropractor and all of my ribs on the right were indeed out of place. The pain under my rib didn't go away entirely after they were "put back" and it often feels like some organ is being pinched or twisted. One day after an adjustment I leaned over to pick up something off the floor and it felt like I was being stabbed in the stomach, and then I had a muscle spasm sort of pain that traveled from my stomach up through my sternum, and through my sternocleidomastoid. I could also feel my pulse in my stomach as if an artery were going to explode. (That's only happened on a couple of other occassions.) So, I went back to my GI doc and he recommended a pillcam small bowel endoscopy. I didn't feel like he really listened to me at my appt, though, so I got a second opinion from a DO and she said I should have a Hida scan. I know from the ultrasound and upper GI nearly 9 months ago that I don't have stones or even crystals, so after reading your posts on this matter, should I even have the Hida scan? If it shows my gallbladder just isn't functioning, I'll probably still opt to keep it for awhile. My aunt had her no-stones gallbladder removed because Hida scan showed hers functioning at 4%, but she and I fall into the grey category according to your blog. (She's had no problems since having hers out.) I can live with the pain under my ribs, and I suppose even the nausea, but I just want to rule out anything that could be more serious because I'd like to have another baby soon. Any other tests I should request? What do you think about the pillcam? I'm a terrible hypochondriac, but I have a very high pain tolerance, so as long as someone can tell me I'm not dying from something crazy, then I'll be fine! :)

I'm reluctant to get into specifics because I'm just too far away. I'd make a couple of general comments. I've never heard of a chiropractor who didn't find ribs or something else out of alignment. Particularly with respect to ribs, unless there's been major trauma, which I assume you'd know, it's pretty much a bogus idea. Sort of like gallbladder flushes.

If you wouldn't do anything about the results of a HIDA scan, I suppose there's no point in having it. I find HIDA scans hard to evaluate, unless the symptoms are pretty classic for gallbladder colic, which yours don't seem to be. On the other hand, other than cost, there's not really a downside.

I'm not in a position to say whether you are "dying from something crazy." Nor, really, am I able to give a meaningful suggestion about the pillcam, mainly because I don't think I can know enough about your situation. You have a lot of "doctors" in the mix. Naturally I'm more inclined to trust MDs or DOs, so I'd say if you feel good about your GI doctor, you should stick with him/her and keep at it. Having several doctors at once working on the same thing but not in cooperation seems pretty complicated. When symptoms aren't typical, it can be difficult for patient and doctor, and can take time to sort out.

Thanks for your reply so quickly. I guess I've been frustrated with my GI doc because he seems to dismiss my symptoms as not having any real cause and just prescribes drugs every time I go to his office. It takes a long time to get in to see him, a few hours at his office each time I go, and then I leave feeling let down with a prescription in hand (that I don't really want to take) and no other reason for what might be my problem. Since I want to have a baby again soon, I'd like to just have whatever tests necessary to find out what's wrong instead of dragging it out. The DO I went to I think was a bit surprised my GI doc had never ordered any blood tests to rule anything out. Something that she did since he hadn't in a year of visiting him. Is it typical for most GI docs to just prescribe meds without delving much further into a cause for a problem? To complicate the matters, we are planning to move to another state within a couple of months. I'd like to at least get the ball rolling so I don't have to drag out having my second child even longer. I've been going to the GI doc since last September to find out what the problem was so I could get it taken care of and then get pregnant. Thanks for letting me rant. I really value your professional opinion on everything (even though you can't give me one on my situation particularly) because you seem like a really knowledgeable, witty, patient surgeon with a great sense of humor. On the HIDA scan note, the only reason I guess I'd have it is so that I could know that maybe my GB IS causing some probs if it's not functioning well, so I could just move on and have a baby. Do you know of any pregnancy complications that can occur from having a non-functioning gallbladder?

HiThankyou for your interesting reading about the gallbladder. I am a medical proffesional as well but til now havn't really dealt with the gallbladder. So here is my ordeal. 4 months postpartum I started having RUQ pain. Eventually while at work I was talked into being seen, with what seemed to be classic gallbladder symptoms, All of my tests including LFT's and u/s came back normal, I was told I had a "fatty" liver but besides that everything looked ok. Almost a month later, I had a terrible attack, this time it also included vomiting. I have been out of work for a week now because the pain is so acute. I have been barely eating and taking my zofran and pain medication daily. A few days after the attack I was feeling better (not great) and had my hida. I came back with an EF of 28% borderline, but lucky for me(not really) it caused a terrible attack. My pcp is sitting on this, but according to some coworkers it seems like I have the option to push for a surgical consult or a GI one. I do know my gallbladder filled fine, it just didn't empty.... I know I'm going to have assert myself to get my primary to send the refferal and just wanted a surgeons opinion on the matter!Thanks so much

I really have no way of rendering an opinion on a specific case: I simply don't have the information available to people who'd actually see you and review all the data. From the little I can know, yours seems in a gray zone. So it would seem to make sense to start with a non-surgical opinion and go from there. Where it ends up, I have no way of knowing.

anonymous: Did you even read this post? Here's what I said about the flush:

Let's start with a gentle statement of fact: OF ALL THE BOGUS, DISHONEST, DISINGENUOUS AND STUPID BULLSHIT THAT MASQUERADES AS ALTERNATIVE MEDICAL METHODOLOGY, "GALLBLADDER FLUSH" IS AT THE TOP OF THE LIST. THE PURVEYORS OF IT ARE, AT BEST, CREDULOUS; AT WORST, THEY ARE CHARLATANS AND (LITERAL) SNAKE-OIL SALESMEN WHO WILLFULLY DECEIVE AND STEAL FROM THE SICK AND THE VULNERABLE, AND ARE TO BE COUNTED AMONG THE SCUM OF THE EARTH...

There's more, if you read the post.

As to alternatives to surgery, I discussed that in the post as well. But you need to read it to find it.

I was recently diagnosed with colelithiasis. I have just one gall stone which is 9mm in size. There is no indication of gall bladder wall thickening and I haven’t had any serious symptoms of acute pain. But yeah the frequencies of stomach aches have increased. I did meet a surgeon and was told that the gall bladder had to be removed some day even if it was not in the near future. The surgeon says that the gall bladder stops functioning once a stone is formed. Is it true?? Am just a lil apprehensive about the entire functioning of the gall bladder as I would’nt be having it after the surgery ;). I happened to read an article on Gall bladder flush out, thought it was a hoax. I found your comment posted there, and was happy to see that I was thinking right about the flushing mechanism.

Well I would have been more than happy if it was true, :) but then now I would be undergoing the surgery by next weekend. I have few questions (just for clarification) and I hope to get the answers from you?!! 1)Are there going to be any side effects after the surgery and am I supposed to follow any particular diet?2)Since there have been no serious symptoms, is it okay if I postpone the surgery? (the gall stone is seen at the neck of the gall bladder and I just don’t wanna have it stuck at the duct)3)Is there no other remedy for gall stone removal other than a surgery?? :(Well these are some of the doubts I have, and i hope to get it cleared from you!

shruthi: if you go to the main page of this blog and look for the second post, called sampler, and find the links to my various posts on the gallbladder (including the entirety of this post!) many of your questions will be answered.

As I've said elsewhere, when there are stones, or a stone, there's no way to predict what will happen. Some will never cause trouble (the gallbladder keeps functioning normally); some will have problems, of the type I've discussed. Timing of surgery is usually elective. I rarely tried to talk someone into it if they were having no symptoms. In my other posts, I've also discussed the possible side effects of surgery, and the fact that most people have none.

I recently had my gallbladder removed and they found a lot of calculi in the gallbladder. Prior to having the gallbladder surgery, I had a sonogram and a CT scan to rule out kidney stones. Both tests indicated that my kidneys were stone free. Now on a recent CT scan, it is showing that I have several small kidney stones. Are gallstones and kidney stones related? I am just wondering if now that I don't have my gallbladder they have decided to form in my kidney!Thanks.

Thank you for waxing eloquent about this subject! If I may pick your brain a little bit, I have a few questions.

I had acute gallbladder attacks while I was pregnant (now over 2 years ago - I did have an US that concluded I had several small stones). The pain subsided once the baby dropped. I had no attacks for over 2 years, but had 2 recently (a month apart in Aug & Sept). I had written off surgery completely due to a scare I had after having my wisdom teeth out (They had problems waking me up afterward). I want to have another baby (or 2) and I was wondering about the medication you said can break up the stones. Can you take it while you are pregnant? If I opt for surgery, how long would I have to wait to get pregnant? Is it true that the risk of certain cancers increases with the removal of the gallbladder?

I would appreciate any advice you could give me. I recently tried a flush (sounds like it was a lame idea - it was not very fun - Olive Oil - UGH)! I went in for an US a week after the fact and the gallbladder was contracting so they couldn't tell if I had stones or not (although they guessed that I probably still do have them). I am due for a catscan in a few weeks to see what is there. I'm trying to do all I can to avoid surgery since I'm usually asymptomatic.

Danya: Here's what one source says about ursodiol (Actigall) during pregnancy:

Pregnancy: Ursodiol should not be used in women who are or may become pregnant. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be appraised of the potential hazard to the fetus. To date, no reports of adverse reactions have been filed. In pilot studies, ursodiol has been effectively used for the treatment of cholestatis of pregnancy during the last trimester without any side effects.

You'd want to check with your OB about timing of pregnancy after surgery, but assuming you had it done laparoscopically, I'd think you'd want to wait until you got home to begin trying.

Gallbladder cancer is very rare, but occurs virtually only in people who've had gallstones for a long time. Here's a statement about gallbladder surgery and colon cancer from a journal:

The researchers analysed data from more than 600,000 subjects to assess the risk of colorectal cancer after cholecystectomy. The findings suggest that if 10,000 people who underwent the surgery were followed for 10 years, 119 would develop colon cancer. By contrast, among subjects who did not undergo cholecystectomy, the number was slightly lower - 86. Simply having gallstones raised the risk of colon cancer to a similar degree as cholecystectomy, which also supports the bile acid exposure theory.

Here's the point: people who form gallstones have a difference in their bile chemistry from those that don't. Since all the bile you liver makes ends up in the colon whether you have surgery or not, it appears not to be about the surgery, but about the fact that some people have different bile. Even then, the difference between gallstone formers and "normal" people is very small. It does seem to be a good idea, however, with or without surgery, that you plan on a regular process of colon cancer screening.

Thank you very much for your comments (and the laugh about getting home before trying)! I'm sure I can wait at least that long! :) We've waited 2 years, what's a few more months... I wish I could gauge the likeliness of having more attacks during pregnancy, but like you said before, it's that elusive crystal ball. I do know that I don't want to be pregnant and have to suffer again like I did before. That's scary not just for my health, but for the baby's as well.

I recently had a sonogram, and my Dr. called to say I have sludge in my GB. I have never had an acute attack, but I have been experiencing discomfort (fullness, burping, gas), and also a persistent (for 2 months) discomfort in my URQ right below the rib cage that gets worse when I turn or flex it - it feels muscular in nature to me, but if I do something like a situp, there is no worsening of the discomfort.

I have three questions from this that I hope you can answer:

1. Does the discomfort in my URQ fit "typical" GB problems, or should I look elsewhere?

2. Is there anything I can do about the sludge? (I am on TriChor, and read somewhere that a side effect of that could be stones, and wonder if this might be caused by that, or a precursor to them.)

3. While my Dr. said I have the sludge, she did not mention anything as a follow on test / treatment - any ideas on things to pursue next? I am not comfortable w/ my current state, and fear it may lead to a full-on attack if not checked.

randy: I'd say your symptoms are not "classical" for gallbladder source. Sludge is a sort of gray zone finding, the meaning of which isn't always clear; ie, whether it's significant or not. Bile can "thicken" somewhat at various times, dietary, fasting, etc, and it may not mean much. Generally, without symptoms, nothing is done about it. The question is whether you have symptoms, and from here it's unclear: if I had to say, I'd say probably not.

Other than changing medications, or going from pregnant to not pregnant, there's not much a person can do about sludge in the gallbladder. There's a good chance it's not of significance. Might it go on to become stones? Possible.

Thanks for your reply - I do appreciate the time and info! BTW - I am a male so getting / not getting pregnant is pretty cut and dry for me... ;)

I am currently scheduled to have a HIDA scan w/ CCK, and have a follow on question for that - in addition to the sludge, the sonogram also showed a hemangioma in my liver - should the HIDA scan provide diagnostic results for the GB and the liver, or only one or the other? (I am getting conflicting answers from my Dr. & the nurse)

I am a little confused by your thought on my being asymptomatic - I do have discomfort in the URQ (I hesitate to call it pain at this point, though it does seem to be getting worse.) What really concerns me is the length of time I have been having it - for almost 2 months now - most of what I have been reading incicates that the pain would be more sporadic, not consistent like mine - any thoughts on that?

randy: when I said "asymptomatic," I meant that I don't think your symptoms are typical of gallbladder symptoms, and that, therefore, there's not a correlation between the sludge and what's going on. Yes, you have symptoms. The question is whether you have symptoms related to gallbladder.

The scan will tell nothing about the hemangioma. Those are common are rarely of significance; if it's felt necessary to confirm what it is, other tests are necessary.

On this blog, I really can only give general information and advice. The more specific the situation, the more uncomfortable I am providing information, because there's no way I can be as fully informed as your own doctors. Specifics of your case are best addressed to them.

I had a biliary colic experience recently, and they found "some" 2mm stones in my gall bladder via ultrasound.

I have been on a weight-loss plan for about 8 months and have not eaten very fatty meals. I have a theory that the reason I formed these stones is because my gall bladder held onto the same bile for too long. If I had periodically eaten a fatty meal, my gall bladder would squeeze out the crystalizing bile, and it would be refilled with "fresh" bile. Your suggestion that a person avoid fats contradicts my theory.

Back to my gall bladder. The surgeon says have it out. Doctor says do a flush, follow with an ultrasound. He claims that he has had 3 patients in the last 2 years who have had pre and post ultrasounds and the flushes worked.

At this time, I have no symptoms. I have done one "flush" so far. And yes, I ejected what most certainly were olive oil pellets. I will do two more "cleanses" and take the ultrasound. I have and will follow these programs carefully so as not to cast doubt upon the results.

Because my stones are small, it makes an interesting study. The smaller stones are more dangerous as they are more likely to leave the gall bladder and get stuck elsewhere. They are also perhaps small enough to be affected by the various changes caused by the programs.

If the follow-up ultrasound shows these small stones are still there, we have further proof of the hokum that is the "Liver Gall Bladder Flush." If they are gone, well you can add that to your list of medical curiosities.

I will bookmark this page and will let you know by the end of 2008 (dec 31) what happens with my ultrasound. If they are gone, I will post links to the scanned documentation.

Significant weight loss is associated with gallstone formation. 2 mm stones are at or below the limits of detectability (that's smaller than a tenth of an inch!) and may or may not be real. If your weight stabilizes, the makeup of your bile may do so, also. So there are several reasons why followup ultrasound might not show anything. Among them is NOT the flush. There simply is no physiological basis for it. (And whatever you saw in your stool is, by its size alone NOT gallstones, which based on the 2 mm size would hardly be visible in stool.)

"2 mm stones are at or below the limits of detectability ...and may or may not be real."

--They were real enough to cause 2 episodes of biliary colic.

"So there are several reasons why followup ultrasound might not show anything. Among them is NOT the flush. There simply is no physiological basis for it."

--There is at least one physiological basis that comes to mind: if I drink a bunch of olive oil, my gall bladder might contract, emptying itself of bile and possibly some small stones. Or is that not correct?

" (And whatever you saw in your stool is, by its size alone NOT gallstones, which based on the 2 mm size would hardly be visible in stool.)"

--I understand this. As I said, the things passed were quite obviously digested olive oil. As you said, if I passed the 2mm stones, I would not have noticed them.

What I gather though from your initial response is that if I were to present documentation of an ultrasound showing that my small stones were no longer in my gall bladder; you might claim they were not real (though they caused 2 episodes), or that the 2nd ultrasound did not detect them (even if they were still there). That being the case, I won't bother posting the results here.

Nonetheless, I do appreciate this site and your tireless efforts to provide this information.

Hello.My ultrasound showed 'innumerable' gallstones; and my doctor scheduled a consultation with the surgeon. I met with the surgeon today which resulted in being scheduled for my surgery. I did ask the surgeon if he saw my ultrasound and he said all he had was the written report. (Same as I had, with the report.) Should I not be concerned that he has not actually looked at the ultrasound before wanting to do surgery?

generally there's nothing to be learned from actually looking at the images of the stones; I'd say many, maybe even most, surgeons don't feel the need to look at ultrasound images of stones if the report is clear and the situation is straightforward.

My surgeon did not hesitate to emphatically recommend surgery (though he too did not see the actual ultrasounds).

Interestingly, Dr. Schwab said that my stones of 2mm in size were at the limit of being detectable and may or may not be real.

I have had no symptoms since the initial episodes of BC. The fact that I have done one "flush" treatment, and am trying some other alternative medicine treatments may or may not have anything to do with this.

For the record, I have not paid any money to anyone who promotes these methods. The instructions for the flushes are found for free on the web. The supplements and other ingredients are ubiquitously available as general merchandise (olive oil, epsom salts, citrus juice, apple juice, etc.). So there were no money-grubbing charlatans involved in my alternative treatments.

It is clear that many of the claims with the flushes are either dishonest or blatantly mistaken. It is also clear that the cystic duct is too small to pass these giant stones. I do think though, that in my case, where my stones are tiny, and "may or may not be real" there may be some merit to treatments that change the composition of bile, and help to pass very small stones.

Well, the nice thing is they're (the flushes) not harmful (other than, in some people, delaying needed treatment). That they are ineffective is not in doubt by anyone who understands biliary physiology.

Thanks Dr. Schwab for answering the ultrasound question.I had done the flush (recommended by many) hoping to avoid surgery back on 10/24/08 and yes, green things magically appeared. However, the pain made its way back. I thought it best to acknowledge and listen to my doctor with the surgeon recommendation. Thanks for taking time to respond!

For those wondering whether to avoid surgery or do it, let me tell you surgery for me was well worth it! I had intense pain in the softpart of my stomach, veering more toward the left. I knew it was not ulcer,acid refloux,or heart burn related; to me it felt more like a hernia. Sometimes the pain would wrap around the rib in the back, something like a runners stitch. It didn't really matter what I ate, anything that went in took a slow process going down. I was surprised when the ultrasound showed stones. The pain for that usually relates to the right. I took some digestive enzymes which were a waste of money. I tried a flush, which burned my bung hole so bad from all the citris coming out. Then I found this blog, which answered any doubts or questions that were still lurking around. I scheduled my appoinment with my surgeon and had the lapo surgery done on 11/26/08. Surgery was quick and the healing process is as well. I should have stuck with my doctors advice from the beginning rather than getting side tracked with all of the alternative nonesense. Perhaps if the ultrasound did not show stones, then the process of elimination path would make sense. In my situation, I delayed the solution causing more unnessary pain. I have no more pain in my stomach.

I recently had my gallbladder removed (lap chole) about a month ago. Is there any truth to what I've read on the internet, that you need to supplement your diet with herbs/products to help you absorb omega-3 fatty acids and other healthy fats that used to be absorbed by your now-removed gallbladder? For that matter, are there any particular supplements or dietary changes that you need to make post-surgery? All my surgeon advised was a low-fat diet. Thank you so much for your response. I just found your blog and read your comments on "flushes"....very informative and entertaining!

If you were to read the rest of my posts on the gallbladder you'd get your answers, I think. The second most recent post has a link to them all.

In short: no need for any supplements. You still have all the bile you ever did, and that's what helps absorb certain vitamins, etc. The gallbladder is just a storage pouch and has nothing to do either with production of bile or of anything to do with digestion or absorption.

There's a lot of great information on the internet, and a lot of misinformation. But not here!

I had my gallbladder removed via laproscopic surgery 12 weeks ago. All has healed well.We are looking at trying for another baby, Is there any magic time frame that one should wait before trying to concieve after gallbaldder removal?Many thanks for your time. Pondering...

I was told today that the ultrasound shows there may be a very small stone (not definite)blocking the duct. My liver enzymes have been high on some days. Ten years ago I had severe pain. I was on birth control pills then. They could not tell me 10 year ago what was wrong. However, now the doctor is recommending unblocking the duct and also removal of gall bladder. I have not had any pain recently. He said since I have a stone their may be others. I am 50. Please help.Thanks in advance.

I'd really like to help, but there's simply no way to provide specific advice without being directly involved. I try to give general information, but without knowing the sorts of things I could only know by seeing you and your records, I can't do more than that.

If you aren't comfortable with the advice you are getting, or don't fully understand it, you should either let your doctor know your concerns to get clarification, or get another opinion.

Sid, I have been diagnosed with gallbladder diseased caused by gallstones, and while I am relatively young and healthy, I would prefer to investgate any viable nonsurgical treatments. My general working hypothesis is that I need to correct my awful diet and overweightness anyway, and I think if I can just rid of the stones, I may have a decent chance of them not recurring. (I do not have most of the epidemiological risk factors.) I know that the adverse consequences of a cholecystectomy are relatively minor, but personally I feel even these consequences are substantial when it is possible that there are not-surgical alternatives.

On the Internet, contact dissolution with MTBE looks like the most viable alternative. My problem is I have no idea how to find a doctor that can perform this procedure. The folks at the ER who diagnosed me hadn't even heard of it. Do you have any advice on how I would find a doctor?

Also, what I totally don't understand is why gallstone lithotripy has been apparently abandoned. As an adjunct to ursodiol therapy it seems like it could be reasonably effective, and minimally invasive. Is it just that most patients prefer the quick fix? I don't see why someone would prefer the general morbidity and health impact of even minor surgeries when a few lithotripsy sessions and months of oral medicine would be sufficient.

Aaron: In my area, the Mason Clinic was doing MTBE infusions several years ago. I don't know if they still are, nor do I know of any other places. Similarly, not many are using ESWL any more, either, for lack of good results. As I said in my posts, the fact is that most who get stones tend to get them again, whatever nonsurgical method is used to get rid of them.

On the other hand, it's always made some sense to me that if there's an identifiable cause -- such as pregnancy, obesity, etc -- that can reasonably be predicted not to recur, then dissolution, etc, seems reasonable.

Ursodiol effectiveness depends on size of stones and chemical makeup (ie, not too large, not calcified). Using ESWL to make big stones smaller before trying urso has logic, as well. There have, as you might expect, been cases of common duct stones and pancreatitis associated with ESWL.

You might contact the digestive diseases department of Virginia Mason and inquire if they are still doing the MTBE infusions, and/or might know where else it's being done. If at all.

I read through your entry and most of the comments, and I don't think you've touched one person's question which I also find interesting: doesn't avoiding fatty foods when one has gallstones WORSEN the situation instead of bettering it? Because if the GB is not stimulated to contract, wouldn't bile stagnation possibly cause the formation of more precipitate (ie. stones)?

I find that doctors in general treat only immediate symptoms without looking at root causes. Of course, avoiding fatty foods might stop GB attacks, but in the meantime, if MORE stones are thus created... it seems rather pointless unless one hopes that the stones are slow in forming - which they are not necessarily. Please correct me if I am wrong, as I would like to understand this (as an aspiring med student).

I find that doctors in general treat only immediate symptoms without looking at root causes.

Hopefully, if you go to med school, Alice, you'll learn how simplistic and wrong that sentence is...

As to diet and gallstones: First, gallstones may increase in number over time for many reasons. Second, the number of stones has not much importance. Size, maybe, in the sense that smaller ones can pass and cause problems; but having ten makes you no more at risk, in general, than having one. Some people have hundreds.

Absent complicating health factors, the main reason to operate is to relieve symptoms. If a person controls symptoms adequately with diet and is happy with that, fine. If, during the time of avoiding surgery, the number of stones were to increase, that would not affect (in my view, anyway) the decision to operate, assuming symptoms remained controlled.

Nor is it the case that bile in the gallbladder remains stagnant absent a fatty diet: the gallbladder fills and empties throughout the day, generally speaking. It contracts when you eat anything; more strongly, usually, when fat hits the duodenum. But not exclusively. So in an unobstructed gallbladder, bile is not stagnant, no matter the diet.

Also - have you ever seen the stones (or whatever they are) passed by someone having done the gallbladder flush??? Are you absolutely sure that they are not at all like those that you take out of patients' gallbladders by hand???

Because some do look calcified, you know. Not that I would really know, but they "do" to an untrained person such as myself. They really are quite convincing (erm, to the lay-person): they have this layer of whitish-beige, almost flour-like (mixture of flour and fine sugar) substance on the outside, and are beigey-yellowy-green or grey-green inside. The outside sort-of peels away, and the exposed stones (as well as the "uncalcified" ones) are quick to oxidize and somehow "dissolve" in air, or rather, liquefy. Is this typical of GB stones? Could it also happen with olive oil, um, pellets??? Why would the olive oil liquefy at ambient temperature? Is it because the bile holding it together would have broken down by oxidation?

I just can't think why they would look that way if it were only the oil having "coagulated". With the "calcification" layer, that is.

Do you sometimes also remove stones from the liver??? Have you ever found any in the liver???

Oh, shoot... I misread "cartons" for "cartoons" in your post, and wondered why on Earth people would draw (cartoonize?!?!) their pooped-out stones instead of bringing them in.

So you have seen them. Aah.

Why would the curds have different colours within a single movement, though (emerald-green, grey-green, yellow-green, beige)? (I'm not trying to prove you wrong or anything of the sort - I'm just genuinely interested.)

The curds I saw were always yellowish. I don't know where it's said they are multicolored, but perhaps they are. Whatever. Still, they are as different from gallstones as cottage cheese is from toffee.

One thing I've always noticed when looking around on the net, most often one will find that the person who has a blog or website also has something for sale. A little insight into my "now previous problem." I had an attack a few weeks ago-had never had such a thing and yeah, I love fatty foods but seem to have an iron stomach. Years ago I was diagnosed with an ulcer and a hernia from the quack of a family doctor we had had for years (he was about 64 yrs. old at that time). Little did I know that after taking months of ulcer medications etc., had this guy been the intern I met later when the old quacker was on holidays, the BACTERIA I had was actually the problem. Antibiotics cured it while quack doctor had promoted the sh*t the companies wanted him to.

My thoughts on the free Flush info I got recently and instead of Olive oil I used sunflower oil and grapefruit juice. Trust me on this too, years ago my now departed father HAD gallstones and I still have them in a glass vial-they're about the size of a man's thumb up to the knuckle. Whitish gray in colour and hard as chalk, black flecks all over. Pops LOVED pepper and would have sprinkled it on icecream if it made it taste better.

The flush I did a little while ago and found on a site that promoted nothing else but this potential cure, advised apples & apple juice, epsom salts and water, (an)oil and citrus juice.

So, had I gone to our family doctor's group-same place, newer and somewhat younger practitioners now though(in their late 40's to 50's), they'd have wanted to rip out my GB to be sure. GUARANTEED!

The intern I had years ago, I spoke to him prior to doing this flush and guess what, even though he could use the visit and of course get credit (revenue) for such a thing, advised that he's an advocate of such a trial run. He is not involved with our family group of doctors and we can't join him at his as he's packed solid with patients.

14 smaller stones came out, similar-VERY SIMILAR to dear old dad's, I took these to him and yep, G A L L S T O N E S!!! I used lighter oil than the first advised olive oil, so tell me why my stones are just like dad's: chalkie ones????

Remember this too, I repeat, the site I found this info on, was selling NOTHING, no books, no kits, NOTHING!

To give you even a better example of how some docs are too freakin' old to still be in practice, years ago I had an ingrown toenail on my left foot-the BIG toe. Same old codger advised that Penicillin would work yackety-yak, he went on holidays after I had the penicillin for about 4 weeks already and it was NOT working and heavens, you mean penicillin taken by mouth can't find its way down to your big toe and solve the problem? Sheesh! Same intern was there again, told me the nail MUST go and RIGHT NOW. 2 huge needles in my big toe and they ripped it out, it has grown back since then and presto, never another ingrown again. If the old guy was still there he'd have told me to go to Stress Relief Management classes for what ailed my recent GB problem, to be sure. 2 weeks now and I'll tell you, I've had additional proof as my wife went for an ultrasound for female issues, doctor in a well respected office confirmed exactly what I mention above, mine ARE gallstones. I saved this part for last and should advise that I live in Canada and in my province we have outstanding free coverage-would have been free to have the GB ripped out but why would I do that considering it's a valuable organ to begin with.

I'm just saying, when one gets a high fever with an attack awhile ago, gets what appears to be pain similar to a heart attack in the chest area (sternum), pain roaming from right side to back to groin area and high amounts of heat emanating from their body-i'm always about 97 F but when I hit 99 I'm actually running a high fever, why did it all vanish when I pushed these stones out. I still continued to eat fatty foods-porkchops with fat, cheesecake, fried springrolls and for Christmas Dinner we hit a Chinese Food restaurant like we've done for the past 30 years etc., pain did stay the same until I flushed and it does work, prior to the flush I purposely pushed it to the limit and would do it again if I had to. Oh yeah, blood test etc. about a year ago and The Quack Office we still must visit as it's getting harder to find doctors nowadays, they would have missed these for sure!

Yes, I've seen the many sites where you can buy the book or order the kit but then again I would trust someone who advised something for free and I'd still look for more info to confirm that advice. I have a book from John Lust-The Herb Book circa 1974 and from what I know of far too many quacks, Herbs never work huh? Bad for business I guess, Parsley, Ginger, Avocado, Ginseng etc. are not pharmaceuticals!!! The uniformed don't know this but many pills are actually derived from such things but the quacks hate it when they won't get the bucks to promote the other stuff. Same for my Chiropractor I had when a teen, our family doctor back then advised see-saw motion, stretching etc. for my teenaged vertebrae and the growing pains I was having, Chiropractor snapped the pain away instantly and guess what, he's been ours ever since and we're talking over 30 years now. Not such a sham now I guess, Chiro's are well-respected today, so much that our Govt. Auto Insurer in MB sends those who have been injured in car accidents, to many such doctors.

Don't knock the flush until you're certain it never helps others and just so you know about the doc who confirmed mine FOR FREE because he was so curious, he's one of the top ones in our Province today so what would you say about that then? AND he actually DOES understand biliary physiology. To add about the past diagnoses when old quack was on holidays for the ulcer events, the intern shook his head so many times in disgust because the quack's desire was to sell the pills and nothing else. Sure, could take those dangerous pills and eat super hot peppers before bed and still sleep with no reflux. Dangerous goods though, we're not designed to take such pills for so long and the old guy was too old to know anything about newer solutions.

Who the h*ll wants invasive surgery if it isn't needed and once gone, the GB ain't coming back now is it?

It's not all voodoo today and when hundreds of thousands have tried something and found different items in their stool, are you really advising that it might just be the olive oil and juice that is what they found?????

What an oasis of medical sense and helpfulness your blog is to come across in the morass of web quackery!

I've just read through your 'flush' thread with interest, after thinking about it again having last seen it 'on paper' in pre-web days.

I was checking it out again because I have had a long term problem with abdominal pain that has at times seemed like it might be gb related (more so lately).

Years ago someone suggested the gb flush, and, having exhausted my options here in the UK (GPs and hospitals generally not interested unless one is visibly dieing) I thought it was worth a try. I was a lab tech back then and did half expect that 'stones' from this process would be some sort of reaction products of the oil and fruit juice, but I thought it probably wouldn't do me any harm to have a good clean out anyway, so I had a go.

Now it was quite a struggle to actually drink any quantity of olive oil and lemon, but I eventually got it down and lay back for results...

There followed what was at the time the most awful night of my life. It did actually seem that my belly was going to explode (I'm male by the way.) so utterly distended did it become, and I could do nothing all night but roll about in agony.

Eventally the stuff did work its way through and was explosively expelled, and yes there were soft little green raisin blobs; and yes again, they soon melted back into being just olive oil...

Now, the thing is, before that time, I had had the 'gall bladder pain' but not the blowing up.

Over the years since, blowing up has become more and more a feature, so that now, I can't do anything without blowing up and getting pain in midrif and right ribs that radiates up to the right shoulder. It goes down again if I lie down and massage under my ribs gently for some time, and goes down over night - though there are still periods of burning in the midrif over night.

Now the curious thing is, that I recently did manage to get my doctors to do ultrasound and CT scans, and they did not show anything untoward (so I am told).

I did, get to talk to the US tech while he was looking, and he commented that my liver 'was rather bright' and that I had cysts in my kidneys, but that these were not a problem.

So I am stuck with being pretty well imobilised by this blow up and the pain that goes with it, but can't get doctors to help because the tests they have chosen to do apparently don't show anything.

So the question: Why did my belly blow right up to bursting when I took 'the gall bladder flush'; What would be the mechanism that could cause this effect in me, when it doesn't seem to happen to most of the people describing the technique's use?

It would seem to indicate something like the gb reacting to the oil in an adverse way, but how could this be if the standard imaging techniqe does not show anything? What else could it be?

I've been puzzling about that reaction to the flush for some time as it does seem to have significance for my problem. Perhaps, with all your experience you might be able to explain it.

spamlet, I wish I could offer something specific. If your abdomen was literally distended, it's not really explained by gallbladder, especially if there were cramps associated with it. Possibly a partial bowel obstruction, which could be due to various things, from adhesions (not all of them come from previous surgery) or inflammatory bowel disease, or other problems including tumors of various sorts. True "bloating," by which I mean actual protuberance of the abdomen, suggests something mechanical, at least to a surgeon. I can only suggest having a gastroenterologist involved.

It is so good to be able to ask somebody who really has the experience to give a sensible answer.

Years ago, I did see a gastroenterologist and he did a sigmoidoscopy and endoscopy and did not find anything.

Since then, I had managed to get by at reduced activity level, and not being able to do things like hold moderately heavy bags for example in front of me, or 'pull apart' type actions like opening food packets. These actions would make me feel faint. I could however, manage weights like shopping bags, held in the normal way.

Over the last year or two, this blow up started: similar to the blow up I experienced with the 'flush', but now brought on by walking up hills or trying to walk too fast (ie as fast as everyone else!). The blow up takes all my strength away, and it has more recently started to burn as well.

Thus it seems to be associated with anything that imposes a stress or motion across my 'solar plexus' area - even the vibration of holding a guitar against my ribs can set off like 'flinches' from within the sp.

I am now pretty well immobilised with it, so I did renew my contact with the gastroenterologist, and he organised the ultrasound and CT scan - which drew blanks, though it is no exaggeration to say that I practically had to crawl there. My next appointment has been put back and back as he obviously thinks this is not serious, but I continue to get worse.

When I went back to my GP and begged for help, he sent me for a chest xray - I hadn't asked for one - and this too didn't show anything. A general set of blood tests all came back as 'no action needed' too.

What can I now ask the GI man or GP to look for?

My symptoms are so severe and so reliably reproduceable it seems incredible that medical techniqes can't see what is plain to the eye.

One problem may be in the test procedures. They all seem to take place lying down, whereas, my problems generally come on when walking about, or when in the sitting position.

I only have to sit at a desk for a short time before a burn starts under the ribs - generally starting on the left, before spreading across to the right, where I can often palp up under the ribs and set off some gurgling. (Interestingly, there is a sensitive spot on the edge of one of the right bottom ribs over where the gb would be. This sore spot sometimes flares up and affects the whole rib right round to the back, but at other times it is back to a small point on the rib edge. The curious thing is that if I just 'tickle' this spot with light finger tip palpation, this too sets off gurgles from under the rib.)

If I ignore the burn and go on working at the desk, I find myself staggering ang shaky when I get up. I am then extremely sensitive to cold air and have to get somewhere very warm very quickly as I seem to almost go into shock.

Once blown up and shaky like that, I also find myself confused and anxious. The pressure from the bloat builds up so much that my head and eyes are affected and generally the right side of my chest aches and tracks up to that side of my neck and shoulder. (Similar distress was felt when the GI man pumped me up for the sigmoidoscopy - so many of these effects do seem to be pressure related: but, strangely to say, there is not always a lot of gas coming out following these episodes.)

At this point I am generally anorexic and cannot bear the thought of eating, but, if I force myself, I find that I am hungry, and the food goes down. Then, if I lie down for a while and massage my guts, I gradually stabilise a bit, and can eventually repeat the whole painful sequence. It is not a happy way to spend one's days. And I have now lost a stone since Christmas (Though I was overweight to start with this clearly is not the way to get back to normal!)

The effects are similar but come on more quickly when walking, and if I happened to get caught out in the cold, I have no doubt that it could kill me.

So, thinking about it, it seems that, something is making my insides burn when they should be merely sending hunger signals, and this burn is being interpreted by my body/brain as if I am in a fever (though I do not often have an actual fever temperature).

For this reaction there seems to be a 'trigger' somewhere in the solar plexus/under rib area, that is set off either by being stressed by the sitting position, or using the chest muscles, or by vibration - or by hunger.

Apologies for this lengthy extra info, but I am at my wits end and don't know what to ask my GP or GI people to look for next - what tests should I ask for? Why is there simply nowhere to go where I can find people whose job it is to find out what is wrong rather than what isn't? At the moment it seems that the worse I get, the less anyone wants to get involved.

And with all this there has never been anyone sensible and 'scientific' to ask these questions to.

So thanks on behalf of all us information starved readers, for your very much appreciated blog.

Rereading your reply, a couple more points might have significance on the 'mechanical' side:

When this problem first presented, I was running to catch a train, when it did feel like something inside me suddenly gave, and left me faint and nauseous and cold for the rest of the day. My heart checked out ok but I had to give up such activities though I had pretty well walked cycled or run everywhere up to that point.

The reaction to vibration and the fact that I've had to have one hand on my belly when driving, to steady it over bumps and corners, also points in the 'mechanical direction'.

And also, a coping mechanism I have discovered is that if I lie with my pelvis up on a foot stool and my back on the ground, this seems to reduce the pain and distension, and clear my head too.

Similarly, if I go on hands and knees and let my belly hang down, this also brings some relief. On the other hand I notice that if I happen to lie flat on my back, I gradually get 'anxiety' feelings coming from my 'solar plexus': turn over on to side, or put up hips and they go.

Taken together this indicates a possible mechanical problem where something v sensitive in the 'sp'/midrif is being irritated by weight from above while standing, or lying on back, but is relieved when the body is held in the opposite directions.

Some of your description suggests pancreatic inflammation, although that would likely have shown on the CT scan, or, depending on what they checked, blood tests. There are specific blood tests related to pancreas that probably wouldn't have been included in routine screening.

Likewise, I assume you had oral contrast when you had the CT. If not, then a repeat with contrast, or an "Upper GI with small bowel follow-through" might be useful.

But, really, the only solution will come from sticking with a doctor willing to keep working on it until there's some sort of resolution.

I recall now I was made to drink a lot of not very nice tasting clear solution (Iodine containing?), and they put something (pink?) in my arm too. I don't recall now exactly what this was intending to show, but, as I was told that US wasn't really that good for looking at the intestines, I assume the solution was meant to show these more clearly.

I'll try and ask my GI man about the follow through and pancreatic tests. It's a shame there aren't more like you with your excellent blog.

Is there anything I can do in the meantime to reduce any pancreas inflamation?

Many thanks,

S

(Hmm: I see the word verification wants me to write 'fartio' in the box. Maybe it is trying to tell me something too :-)

I read a bit about it after you mentioned, and saw the 'almost always a record of alcohol' connection. As it happens, I had found - before it got to the fully disabling stage - that sipping some of the stronger, 'smooth'-feeling beers seemed to soothe, while wine seemed to agravate.

I don't really drink that much though most of the time - esp as I'm not getting out now, as I blow up and get weak, breathless and desperate after very little movement. I did make home brew for many years, but have always tried to make it last, and indeed the last bottle I shared was 26y old, and that was over a month ago.

In view of the 'rib' symptoms - today particularly bad on the right side and spreading under my arm - do you think there might be something wrong with my diaphragm, that could cause this and yet not show up on the scans I've had?

Sorry, I don't believe you, sir. I've done my share of liver flushes over the years and have gotten immensely satisfying results. Dr Jack Tips did MRI's or ultrasounds of people with stones. Then they had those people do the liver flush. Another MRI revealed that most or all of the stones were flushed out in 90% of the people. You say they are jagged green turds or curds that look exactly like the stones I've seen in cadavers. So whose right here? Why don't you post some empirical evidence like before and after MRI's or utrasounds to prove it doesn't work? All I can say is that I'm not going to be one of the 750,000 people that you need for employment who will lose their gallbladders to surgeons like you this year.

Wow, Maria, powerful stuff. You did them and feel great. Talk about proof...

How about a link to the studies "doctor" Tips did? (I don't consider naturopaths doctors, as you might expect.)

I'd say the onus for proof lies with fakers like Tips. Show the evidence. Why would you expect scientists to spend someone's money testing something that has no physiological basis at all?

I know of at least one study that took the curds from feces after a flush and examined them chemically. (Ask your "doctor" to get it for you.) Big surprise: nothing in common with gallstones. There are labs that do stone analysis. Next time you flush, scoop some up and send it off. Might cost you a few bucks, but think of the pleasure when you prove me wrong!

If you know anything about bile chemistry and gallbladder physiology you'd know there's simply no way flushes can work as advertised. Can they make you feel better?

You can claim the onus is on me, but you are the one shouting crap from your ivory tower. You haven't shown us a shred of evidence, only your opinions. I've seen the before and after MRI's which is greater proof than some lab analysis. You just expect us to believe your crap because you are a surgeon, like you've got the corner on the truth. Of course you know that doctors are the third leading cause of death in America. That's over 450,000 deaths per year. How many people have died or had their lives handicapped needlessly because of hubris and arrogance like yours?

P.S: Maria, by a strange coincidence, there's an interesting article in today's NYT which shed a little more light on why your flushes make you feel good: it helps if your "doctor" is dumb enough to believe it works, or dishonest enough to convince you he does.

Oh. Okay, you say you've seen MRIs. I call bullsh@t. I don't know anyone who'd order MRI for gallstones: it's ten times more expensive than ultrasound, and less effective at finding them. But as long as you've seen the studies, please direct me to where: before and after images.

Actually, I don't expect people like you to believe me. All I can do is tell the truth, based on knowledge and experience. There will always be deniers, conspiracy theorists, and magical thinkers. It's been that way since the earth began, six thousand years ago.

Allopathic medicine is in trouble-and so are people who rely on it. Medicine's model is based on the Germ Theory of Disease. It is not valid!

The GTD is a "theory"-yet medical science treats it as a holy writ. It is the cornerstone of the archaic medical model under which modern medicine labors. Conventional medical modalities-from diagnosis to treatment-are based on a false, theoretical dis-ease "model." In other words the immune system is nothing, the germ is everything.

What happened to that Hippocratic Oath you took Sid? You know the one that says, "First Do No Harm." You and your colleagues break that one so often that you call it the Hypo-critic oath. It would be funny if it weren't so sad and common...

Come back with data that proves any of your claims. Show me the images of stones gone after flush. You asked me, and I gave you a link which you rejected with a statement that MRI is better than chemical analysis. Patently ridiculous.

We know where you stand. You know where I stand. Nothing will change that until you present proof. Go somewhere else to peddle your stuff. This one is my blog. More comments from you will be deleted unless you have data instead of absurd nonsense.

"Typically, gallbladder attacks happen after eating a fatty meal, so, theoretically, modifying one's diet to avoid fat and any other personal triggers makes sense."Your advice is as ignorant as your opinion. Good fat is an essential part of a healthy diet. Why not tell people to avoid hydrogenated fats and all the other crap that is put into a typical american (Mcdonalds) diet? Why? Because your not a nutritionalist. So don't pretend your one. The "proof" of this cleanse is substantiated by 1000's of testimonials from people have benefited from cleansing. Many of these people went to see doctors like you who told them they could take a "pill" (with loads of side effects) or have the gall bladder removed costing anywhere from $8-10K. Instead they chose to spend $10 on some apples, olive oil and grapefruits. Hardly a scam. The only entity who has something to gain (or lose) is the surgeon. Such a simple procedure for so much money. That's western medicine for you. Why would anyone want to lose a vital organ as opposed to trying a simple, gentle and healthy cleanse? Because some ignorant money hungry doctor told them it's a crock. BTW, the "turds in your curds" disappear after doing the cleanse a few times. You are not a nutritionalist. Your a surgeon. So stick to cutting people open and keep your misinformed opinion to yourself.

It's interesting to me how people who believe in flushes are unable to argue their case with fact, other than "testimonials."

It's interesting to me that there are no studies showing benefit from flushes, regarding any specific pathologic disturbance.

Mainly, though, I'd love to see anyone who claims value of gallbladder flush (let's ignore colon flush, because there's simply no objective basis on which to evaluate anything at all) demonstrate disappearance of gallstones.

But thanks again for dropping by, and for adding so much new to the discussion, in such insightful ways. I loved the irony of your last paragraph, and your use of the word "your." Thanks. I do appreciate humor, especially in these times.

Not gonna get in a pissing match with you, Tyles. No more comments for you, unless you offer something more than the usual claims. Come back with anything -- ANYTHING -- that demonstrates efficacy of gallbladder flush in objective, measurable terms. Otherwise, don't waste your time commenting, and mine deleting.

Your comments are EXACTLY like every other one here from your side. I have provided links to actual studies. You, and the previous clone ignore them. That's how it always ends. (Well, until someone dies of cholangitis or perforation, but that's another story.)

I read your articles about gallbladder flushes. I am not a medical professional, but I have done experiments with my own body and wish to tell you about the results with gallbladder flushes. The results I got fly in the face of what you say about flushes, and you might think of me as one of "those people".

In 2003 I had three painful "gallbladder attacks", each of which lasted about 8 hours. My doctor sent me to get an ultrasound, which showed "hundreds of small stones". I saw the surgeon, but delayed the surgery. I did research and decided to do the flush. I did three of them within a four month period. The protocol was two days of fasting with malic acid capsules, but no apple juice. On the evening of the third day, I drank a half cup of olive oil blended with a half cup of grapefruit juice, followed the next morning by a quart of warm salt water. The first flush resulted in hundreds of .5 cm emerald-green stones and hundreds of smaller straw-colored particles. Each successive flush resulted in fewer stones. With the third flush there were no more stones. No more attacks and no more aches under my ribcage after eating.

In the years since, I do a flush about once a year. I have not had any more attacks.

Two years ago, I asked the gastroenterologist who did my colonoscopy what she thought of gallbladder flushes and if those really were stones I had passed. She said yes, there were gallstones.

I just thought you might want to hear from someone who actually did this and had great results with no surgery, medications, or hospital bills needed. It cost about $1 for both the oil and the grapefruit juice and about $3 for the malic acid.

And my question to you is, since it seems my gastroenterologist knows enough to be doing colonoscopies, what do you make of her comment that my "stones" were real gall stones?

Elizabeth: it means she doesn't know what she's talking about. If you tell me you've had another ultrasound which shows the stones are gone, I'll rethink.

Really, truly: there are facts about how things work. Gallbladder flushes simply make no physiological sense, in terms of how the gallbladder works, in terms of anatomical sizes, in terms of chemistry.

I've seen the curds: they can be convincing, visually. But there are well-known ways chemically to analyze stones. The curds are NOT gallstones. It's as simple as that. And I've NEVER seen a before and after set of ultrasounds that show disappearance after flushes. I've seen the opposite. On the other hand, I HAVE seen ultrasounds that show diminution after a course of ursadiol, which makes perfect physiological sense.

I've encountered many family docs who don't understand some pretty basic stuff about gallbladder physiology. Yours might be the first gastroenterologist I've heard of, but there's a first time for everything.

If you're rolling in money and full of curiosity, get another ultrasound. Let me know what it shows.

I have a question, I have a friend that has a friend that did this so-called flush containing olive oil and lemon juice, this lady was in her fifties and in good health otherwise, she did this cleanse supposely passed her stones and now feels great never better with no stomach issues to speak of, so i wondering if she previouslly did have gallstones attacks which which excuriating and doing this cleance and now no pain at all, this to say the least is confusing when I myself was supposed to get the surgery in september and now it's delayed til october with no set date as of now. I am now wondering if there something better out there instead getting surgery??

Anonymous: I have no way of knowing what problem your friend of a friend was or is having. I can tell you, as I've said repeatedly, that the "Stones" that pass after a "flush" are not gallstones; they are congealed residue of the oil and acid. That, I can promise you. Flushes are bogus. Try it yourself, and then have another ultrasound. (Assuming you've actually been diagnosed with demonstrable stones.) I guarantee you there will be no change in the stones. Promise. 100%.

Some people with gallstones may never have symptoms. Some will have a burst of symptoms and then quiet down for years or forever. Some will have frequent and severe symptoms. Of those that have few or intermittent symptoms, they could do a flush, or dance under the full moon, and if the symptoms disappear for a while they can claim results from either one.

I am having GB problems and leaning towards having that baby removed. I had an ultra sound with no sign of stones. My HIDA scan showed my GB emptying at only 5%. I get excessive gas with or without a meal whether fatty or not. I have been following a low fat diet for about 2 months with only one time I broke my diet. One of my recent attacks I became so nausiated I couldn't eat for a week and lost 10 pounds in one week. I have had a Colonoscopy and Upper GI with a clean bill. I have been working on improving my health through a healthy diet and exercise and slow weight loss except for when I have severe attacks and can't eat. After my HIDA scan I had a pretty nasty attack also with pain and gas and watery stools. I do have two questions after all the research I have done on this site and others that hasn't really been answered. Where does the reserve bile from the liver go after the gb is removed? If it drips into the small intestine does this cause problems down the road such as irritation or cancer?

I've written about that in other posts on the gallbladder, to which you can link from my second most recent post, "Sampler."

The liver makes about a quart of bile per day, nearly all of which drips steadily into the intestine. A small amount, relatively, is stored in the gallbladder. So whether there's a gallbladder or not, most people have nearly all of their bile steadily dripping into the bowel. There's no change in the amount of bile going into the gut, whether there's a gallbladder or not.

Some studies have shown a higher incidence of colon cancer in people whose gallbladders have been removed. Since there's no change in the amount of bile, it's my opinion that to the extent that it's true, it's because the bile of people who develop gallstones is different from "normal" people. In other words, it's not the fact that they've had their gallbladders removed: it's that they have abnormal bile which forms stones, and which many irritate the colon in some way.

The more important question is whether you are indeed having gallbladder trouble. I'm not convinced by what you've described. However, I'm not privy to all the details, so you shouldn't take the word of some guy who's not directly involved.

Hi. My sister had her gallbladder taken out 2 yrs ago, and had 2 ERCPs to remove her gallstones. She was fine for 2 yr. Then a couple of months ago, she had a feeling of gallstone attack. the MRI in ER showed she has 2 mm of gallstone in her bile duct. A GI doctor gave her ursodiol. she took the med, changed her diet, lost weight and just recently had another MRI to check the gallstone. Result shows the gallstone is bigger- 9mm. Dr said the small ones may have passed and this is probably one that was lodged high up from liver duct. So the GI doctor really insisted ERCP, even though there is no more pain. She is very anxious to have yet another ERCP. The GI doctor told her that she might even need more ERCPs in the future because there is no guarantee that all stones will be taken out since some may still be lodged or pushed back high up on liver ducts.

This makes me arrive to my question: is it wise for my sister to hold off (not to have) ERCP since it is not bothering her now. And since, like the GI dr said, she may need more ERCP in the future if some stones finally lodged out of liver ducts and go down the common bile duct. Why does she has to have the ERCP now when it's not bothering her and take risk of having more ERCPs if some more stones go down in her bile duct in the future? What do you think? btw, She's still taking ursodiol.

I can't make specific recommendations from so far away. I can provide some general information.

It's true that nearly all people who have bile duct stones after gallbladder surgery had them before the operation, as opposed to forming new ones in the liver. It can happen, though.

Stones in the bile duct -- as opposed to ones in the gallbladder -- are more potentially dangerous. People can have stones in the gallbladder forever with no problems, and when the problems do occur, they're usually not life-threatening.

Stones in the bile duct, however, are a different matter, in that the problems they cause are nearly always pretty serious: bile duct obstruction, dangerous infections, pancreatitis.

Recommendations that doctors make are based on statistics and knowledge of large numbers of people. No one can predict the future for any individual.

For people with repeated episodes of bile duct stones there are operations that permanently widen its opening into the intestine so future stones can, theoretically, pass without causing problems.

I've read through this blog post and all the comments, and I'm still torn on this issue. I believe that you know what you're talking about when you say the results of a "flush" are curds, not stones, but I so desperately want to believe I can get rid of the stones with a little apple juice, olive oil, and lemon juice instead of having a major organ ripped out of my body. I suppose I'm confused as to why you think people are getting financially ripped off with the flush -- I mean, it didn't cost me much to buy the apple juice! I suppose some people are dumb enough to send money for some brochure telling them to drink olive oil instead of just doing a little more googling.

Anyway, I just had an ultrasound last week that revealed I have many stones in my gall bladder. They don't believe I'm having a problem from it, however, so they're not recommending surgery. I went to the dr initially because of pain in my upper abdomen (just under the breastbone) and the doctor could feel something there. They believe it could be a hiatal hernia and that I'm simply having indigestion, so they told me to take Zantac and call it a day. Here's the problem: I know what indigestion feels like, and this is not it. If I press on the area, it hurts. The pain doesn't connect to what I eat at all. In fact, I became a vegetarian 11 months ago and haven't had indigestion since. The u/s didn't show anything, but they said it wouldn't show a hernia anyway because it doesn't go up that far. Now I'm left to wonder why an u/s was ordered for me anyway (abdomen AND pelvis, for some reason), and I'm left to worry about the gallstones the u/s did reveal. Do you have any idea what the pain could be, and whether it could be related to gallstones?

Lisa, you're not the first to have pointed out that the materials for the flush are cheap. I guess I should have expressed myself better in that regard. The point remains, however. In fact, you have a perfect opportunity to prove me right or wrong: do the flush, have another ultrasound.

I hasten to add, however, that I'm not really serious, since 1) I know for certain it won't work and 2) I don't want to be considered responsible for anything that might happen due to your stones. On the other hand, I guess you tried the flush already, right? So let us know if/when you have another U/S.

But as to your question. I can't make diagnoses from over here; all I can do is provide information. (And generic opinions!) I can't say what your doctor felt, but I don't know of any way a hiatal hernia can be felt on exam. There are little hernias that occur in the midline of the upper abdominal wall that can be tender, called epigastric hernia. Simple to fix; can't say if that's what your doc was talking about.

There are typical symptoms for gallstones, and then there's everything else. It's easy when it's typical; when it's not, it can lead to lots of testing and even then it may not be clear. People have been relieved of atypical symptoms when their gallbladder is removed; others have not. As I've written in my other gallbladder posts, it's one of the frustrating areas of surgical care, both for patients and their doctors.

Thanks so much for your response. No, I haven't done the flush already -- it was just something I was thinking of trying, so I bought a bunch of apple juice in case. Then I got back online and saw your post among many other things that indicate the whole thing is a waste of time, so I'm probably not going to bother with it. I certainly couldn't afford to have another ultrasound done anyway.

I know you can't diagnose from a distance, but I appreciate your giving me your thoughts anyway. I just hate when doctors say "we don't really know what it is, but here -- take this pill and see what happens." I realize they can't possibly have all the answers, but pills and surgery sometimes seem to be all they ever suggest, which doesn't feel right either.

Hi, Love your posts, and also those of others. It's good to have a range of experiences and opinions! Anyway.. I have Gall stones..ultrasound picked these up 2 years ago and also this week after more painful problems. My question is... I also feel- on most days- that I have a temperature and don't feel very well generally- is this related to the stones? I have heard that the gall bladder not working properly can fel like it's infected and an antibiotic like penicillin can work to alleviate this temperature feeling- Your thoughts would be most welcome..thank you!

Gallbladders can indeed become infected, and when they do, antibiotics are typically used. However, penicillin is not a good choice. Fever can come from the gallbladder if it's very inflamed, too, and that can occur without infection.

Obviously, though, if you are feeling unwell, with or without gallstones, it's impossible for me to diagnose the reason which might be related to the stones and might not; and if you are having persisting fever, whatever the cause, at some point you ought to be informing your doctor.

Dear Sid,I want to congratulate you on your Blog and providing such helpful information and advice on Gallstones, associated problems and surgical procedures.I have just found your Blog this afternoon after my hospital visit.I have been for an ultrasound at the hospital today and found out that I have three big gallstones. Hence wanting to research gallstones on the Internet.I have arranged to go back to my GP next week and I feel much more informed after reading your Blog.Thank you very much.I would also like to add that your ability to stay calm and respond politely to all the abusive posters is a remarkable attribute. I am amazed how rude some posters have been to you. Not only are they rude but they do not seem to understand the concept of 'providing evidence' to back up their antagonistic statements and counter arguements (especially regarding 'flushing').I for one really appreciate the time and effort you have put into your Blog.Sending you Peace and Positivity from England.

One question ... if the curds, or faux stones, return to a liquid when left at room temp then how do they form in the body from the ingredients of the flush? The body is warmer, typically, than room temp so logic would reason that if the faux stones turn into a liquid at room temp then they would also liquify at higher temps, right?

My 13 yr old son just had gallbladder surgery 5 days ago. My question is more of how often this happens in kids.

For background info, he was diagnosed with GERD, lactose intolerance, and IBS over the last 5 yrs. We initially sought help for him for flatuance.

They first put him on culturelle, and rantitidine with no help, then prilosec along with lactose free milk and pills.

His doc died this past summer and had to find a new GI doc. We chose a pedi specialist this time, and with the amount of time after eating that he had pain, he chose to do a HIDA. Came back as 0% functioning, no gallbladder emptying with CCK. His pain was also reproduced, much more severe than ususal.

The gallbladder was a very dark purple and seemed overaly large for a 13 yr old. 4 inches long. I'm a nurse and have seen many pics of gallbladders after surgery and none had looked like this.

The good news is that he is now able to drink milk, eat fries, ice cream.. food that hasnt had in YEARS. He has not had any diarrhea or pain associated with food, but I know its early and trying not to be too hopeful.

Is this common in kids. We were told that with our strong family hx of gallbladder probs, that it was more congenital for him. His US was normal, but of course it would be, as there were no stones.

Thank you so much for your time in blogging these entries! I have heard that sometimes stones do not show up on an ultrasound, is that true? If there are no stones, what risk is there of the gallbladder becoming infected?

I had an ultrasound that didn't show any stones, but a HIDA scan that shows an ejection fraction of 7%. I have textbook gallbladder symptoms and had what I believe was an attack in July. I have a referral to see a surgeon next week. I am insulin dependent diabetic, and my grandmother had her gallbladder out at around my age.

Thank you again for posting these and leaving them up! I've read all of them, and I feel much more comfortable about this process now. I have friends who are driving me nuts about this flush stuff. I don't know whether the surgeon will recommend surgery for my situation or not; but if he does, I would be afraid not to have it. I would rather have this done when I am reasonably healthy and not experiencing any drastic problems due to infection, etc.

Anonymous: if you've read all my gallbladder posts you know it's possible to have gallbladder disease without stones, including infection. When there's infection from any cause, it's usually pretty easy to diagnose. When people have gallbladder symptoms but no stones are demonstrated, as I've said, it can be difficult to be sure. In my experience, when the symptoms are "classic" and the HIDA is abnormal AND the injection of CCK during the study reproduces symptoms, it's a pretty good bet.

Side note, which I think I also wrote: if diabetics get gallbladder problems, they're more likely than others to get serious ones.

Interesting that your friends are bugging you about flush: it's supposed to get rid of stones, and you evidently don't have any. Doesn't matter: it's BS, and I'm as sure about that as anything I know. The curds that pass in your stool are just that. They're not stones, they have nothing to do with your gallbladder. As to my challenge, asking anyone who has stones and who has a flush to have another sonogram and let us know the results? Still waiting.

Hi ... you helped me to understand post surgery effects, and I have followed your blog ever since. I am wondering about something. My father's gallbladder is full of sludge (he tells me). He has very uncomfortable attacks every now and then I believe when he eats incorrectly. He is diabetic. Do they ever remove the gallbladder based upon it being full of sludge?

Heidi B: Yes. Often within the sludge are small stones. If there are suggestive symptoms, it's considered significant, usually. And, as I just wrote in a comment above, diabetics are at increased risk of more severe gallbladder infections if they get infected.

Sludge is somewhere along the spectrum between normal and obvious stones; it takes the full context to decide what to do.

I went to the ER late last Wed night and ended up in the hospital for 4 days recovering from pancreatitis. Ultrasound and MRCP revealed no stones in my common bile duct, but but their presumption is that it was a stone that brought this episode on.

They discovered gallstones, no sludge. My gallbladder isn't enlarged, I do have a miledly enlarged fatty liver. To my knowledge I've never had a gallblader attack or any other symptom prior to this. Today I'm feeling pretty well and am eating normally, trying to reduce but not eliminate fat.

The surgeon I saw recommended removal of my gallbladder, as of now this is tentatively scheduled for Friday.

Although I know this is a common procedure, I'm questioning whether immediate surgery is the best way to go. I certainly don't want to have another bout of pancreatitis and I understand the potential dangers of a severe attack, but I also do not want to take my gallbladder out without thoroughly considering all options.

BTW I'm 54 years old, overweight falling into the obese category but I've been losing weight gradually over the last 8 months or so (25 lbs so far, 50 lbs to go), exercising regularly. I've been following a low carbohydrate diet incorporating a goodly amount of green vegetables.

How urgent is it that I have my gallbladder removed now? What are the chances of serious consequences if I wait? Is there any reasonable possibility that I could keep my gallbladder, as far as I know this is the only time I've had a problem.

I hear that removing the gallbladder doubles the chances of getting colon cancer, I'm wondering about other possible digestive consequences of having it removed.

I would appreciate any comments you might have, this was a great article. I only heard of gallbladder flushes for the first time yesterday and had already determined them to be bogus, if they were effective it seems like they'd be potentially very dangerous, as couldn't it cause another bout of pancreatitis for me? I wouldn't consider anything like that without a doctor's supervision.

Kathy, pancreatitis is one of the most severe and dangerous complications of gallstones that there is, and for that reason I nearly always recommended gallbladder removal if it was clear that stones were the cause of it.

The issue of gallbladder removal and colon cancer is something I think I've written about elsewhere on this blog. It's true there was a study that showed a slight (nothing like doubling) increase in colon cancer among people who'd had their gallbladder removed.

In my opinion, a big question remains regarding the relationship: since gallbladder removal results in no change in the amount or nature of bile in the intestine (bile is made in the liver, and continues to be after gallbladder removal) I've thought it might be that the kind of bile that forms stones has an increased tendency to cause cancer. I don't think anyone knows.

People who have gallbladder removal had the same kind of bile before and after the operation. In any case, the study was retrospective, which is less than ideal; and the increase was very small. The authors themselves said it shouldn't be a factor in deciding whether to have the operation.

No one can predict what would happen if you keep your gallbladder. You might have another episode tomorrow, and you might never have one again. I have no way of making a specific recommendation to a person I don't know. All I can say is that, on average, the consequences of recurrent pancreatitis are potentially very serious and the after effects of gallbladder removal for most people (not all people) are minimal to none.

There's no perfect way of timing surgery after an attack of pancreatitis.

Just wanted to update you. I had a laparoscopic cholecystectomy yesterday (11-18-11), and I was able to return home 6 hours or so after they put me to sleep. I've got 3 small incisions, closed with dermabond so no dressings at all. I'm super-sore, but woke this morning with a decent appetite.

The surgeon told my hubby and parents in the waiting room that we'd have to wait for pathology but based on what he saw he was betting that I had cholecystitis, even though imaging hadn't indicated it and there was no tenderness in that area.

I'm glad I went ahead with the surgery, and sooner rather than later. Hoping I'll be recovered enough to be able to attend Thanksgiving dinner with my extended family, even if I'm not able to eat the meal.

One other question that I don't recall seeing brought up on your blog is this procedure:

http://foxnews.com/story/0,2933,296817,00.html

My sister was bugging me to try and find someone to do the surgery this way.

My own personal feelings are that giving birth to two children was enough trauma in that particular area and I'd be hard pressed to imagine that there would be no pain after a laparoscopic incision in that area, and I don't mind a small scar.

Hi Dr. Schwab, I have found your blog to be the best information on gallbladders on the internet and helpful since I am so new to this. I have a surgery scheduled for Dec. 1 to have my gallbladder removed. I am having serious reservations about how necessary it is. My surgeon is just "leaving it up to me" at this point to make the final decision. Could you help me with your recommendation? I am a 43 year old mother of 2..in good health ( a little overweight) which I always chalked up to low metabolism, because my diet and excersize regimen is good. I had 1 gallstone attack that landed me in the hospital..they found a 3.7cm stone (only 1). I have never had a problem with foods and don't eat the typical trigger foods, the day of my attack I had only had a protein shake after going to the gym??? Will removing my gallbladder just cause more problems...like slower metabolism, food intolerance, weight gain etc?? If I only had 1 attack and no other real symptoms is it worth doing the surgery? My surgeon suggested that the surgery would be worth it simply to eliminate the worry of when the next attack might occur. I am wondering if they recommended the surgery due to the size of the one stone..is one stone more dangerous than many and just going to get worse? This is so confusing because I feel great right now..just want to continue to work on losing a little weight. Is it possible that the stone is the cause of my slower metabolism and my gallbladder isn't functioning optimally anyway?? But I don't see how removing it would improve that function..Phew..sorry for all the questions, but can you help shed some light on all this for me?Thanks

Between my various posts and the voluminous comments and responses, I think all of your questions have been addressed. But to save you the time, I'll do what I can. What I can't do is make a specific recommendation for someone not my patient.

Having your gallbladder removed will not affect metabolism, nor is there a reason for it to cause you to gain weight, other than that some people who couldn't eat rich or fatty foods because of attacks can do so after surgery and might gain weight as a result.

How one metabolizes fats and bile salts is a part of whether one gets stones; but it's unrelated to metabolic rate, ie how you burn calories.

As you seem to be aware, there's no way to predict what will happen if you do or don't have surgery. You might have an attack tomorrow, you might have one in six months, or never again. Most people who start having attacks keep getting them; but there's no way to say.

The number of stones isn't predictive of attacks; but if you truly only have one large stone (there can be more, smaller, not visible on the sonogram), it means the chance of having it leave the gallbladder and cause the serious problems that can result from that (common duct obstruction, pancreatitis) are less than if you had several smaller ones.

As I've said repeatedly here, most people have few or no side effects from gallbladder removal. On the internet you hear from the ones who do, but not from the 90+ percent who don't. The most common side effect is intolerance of fatty or rich foods, but it's not all that common, and it's usually easily managed.

Finally, the function of the gallbladder is to store a small portion of the quart of bile that's made every day in your liver. The storage function isn't all that necessary any more because we eat regularly. After removal, the same amount of bile as before is made and passes into the intestine. That's why most people never miss it.

As you might recall, I commented here that I had a laparoscopic cholecystectomy on 11-18 and was doing great, looking forward to seeing my family on Thanksgiving.

Late Wednesday night before Thanksgiving I began vomiting and couldn't stop. Went to urgent care and was admitted to the hospital. They did a CT scan with contrast, found a small hematoma in the gallbladder site, then they inserted a drain.

I felt good on Thursday and was set to go home on Friday, but in the evening began vomiting again. Same with Saturday and Sunday, felt great during the day, then began nonstop vomiting somewhere between 4 and 8 in the evening, sometimes before a meal, sometimes after, also while NPO.

They tried zofran, phenergan, ativan, reglan, but the ONLY medication that would stop the vomiting once it started was dilaudid.

After a great day today and even a regular dinner at the hospital, they sent me home. I started vomiting again around 9pm and it's been going on now for over 7 hours. I'm trying to give my poor hubby some sleep but I'm planning to go back to urgent care in a few hours if this doesn't stop.

Nobody has any idea why I'm vomiting so much. The drain is producing about enough to fill a medicine cup in 24 hours, not much.

Have you ever heard of a situation like this? I'm about as miserable as I've ever been, and hate the idea of being hospitalized so that I can get dilaudid 2 or 3 times a day in the evening, but I really can't bear the nausea and nonstop vomiting.

Kathy, I wish I could help. I've had patients with prolonged post-op vomiting and it can be pretty frustrating. There's a long list of possibilities, and the doctors there will be better able to go through them than I am.

I've never had anyone in whom it didn't go away, though, with or without ever figuring out why.

Hi Dr. Schwab Thanks very much for your response to my post on 11/23. It was helpful and nice of you to break it all down for me. I am literally making a last minute decision here.(surgery scheduled for tomorrow) but I think I am going to try to postpone it. I decided to get tested for Celiacs or Gluten Allergy..I have been hearing alot about the link between Gluten and gallstones and fatty liver (which I also have). Have you heard anything about it? I want to try to explore the possibility that I have this and maybe I can try to reduce attacks with diet changes..especially since I have a big stone that may not get stuck in the bile duct too easily. I am still obviously pretty doubtful and I guess I am just listening to that. I still hear things like..removing your gallbladder can actually trigger celiacs, it can cause reflux or some sort of duodenum (sp?) defect or something, it can also inhibit your ability to absorb vitamins..omega3 etc..I don't know if any of those things would happen..and then hearing Kathy's ordeal..makes me still so unsure.

The only association between celiac disease and gallstones that I've heard (and the articles are mostly speculative) is the other way around: if you have celiac disease you might have a higher chance of developing gallstones.

Once you have gallstones, in a sense it doesn't matter why: it will cause future problems or it won't.

Hi Dr. Schwab, I migt be sending this twice (accidentally) but I wanted to update you about my surgery. I went through with it at the urging of my family and surgeon..the 11th hour jitters were just not cool. But the stone that she ended up removing was HUGE! Like you could break a window with it huge. Had I known that I was providing a home for that thing I never would have doubted surgery. Everything went well and I feel fine. I will be following up with a nutritionist to make sure my diet is on track postop..but I think I did the right thing. That stone was going to give me nothing but trouble. My stomach sort of swelled up last night after I ate, which was weird..but I think I am recovering pretty well so far. Anyway..thanks for your advice and patience.

I don't want to scare anyone away from surgery with my ordeal, about 15 of my facebook "friends" have had gallbladder surgery, some of them are 10+ years out and I have yet to hear of someone who's had an experience even remotely like mine. My surgeon was so surprised, he said I was such a perfect candidate, in good health and good shape and no complications, he was expecting smooth sailing and for the first 5 days it was going smoothly.

My incisions are mostly healed and look great, no more abdominal pain, the drain is gone, and after spending 7 hours a day vomiting for a week, I haven't had an episode of nausea and vomiting since Wednesday. I'm walking on eggshells afraid for the next shoe to drop, but outside of being completely exhausted I'm feeling pretty good and am back to feeling hungry between meals and eating, choosing my food carefully.

My surgeon's theory is that I had a small hematoma where the gallbladder used to be, he said there were gas bubbles indicating some bacterial activity and I had an elevated white cell count when I was admitted on Thanksgiving. He said that the antibiotics would have taken care of any infection on their own, but he inserted the drain both so he could check to be sure there was no bile acid leakage and since I was so utterly miserable he was hoping that the drain would speed up my recovery.

But the vomiting recurred, every day once a day for 7-8 hours and nobody seems to have a real reason why. All the antinausea drugs that have worked for me in the past, zofran, phenergan, reglan, ativan, made absolutely no difference in this case, the only drug that helped was IV dilaudid, the effect of the pills was much less.

My own theory is that the vomiting was more of a neurological thing, like my brain in an endless loop saying, "I need to vomit, I need to vomit, I need to vomit" and for some reason, some incidental effect of the iv dilaudid rush was to interrupt the cycle in my brain that was leading to my nonstop vomiting. I was never in pain except for the pain caused by the neverending gagging and retching, once the gagging stopped so would the pain.

Anyway, no narcotics now since Wednesday, I'm taking half a 1mg ativan twice during the day and a whole one at night, getting back to being able to endure the sight and smell of food and eating. The surgery was outpatient and went really easily, I felt like I was recovering quickly, painful at first but the pain was decreasing by an order of magnitude every day. If it hadn't been for being hospitalized for a week with such severe nausea and vomiting the whole thing would have been a minor blip.

Now I can laugh, swivel and bend without pain, and if I can keep the nausea at bay everything will be good. But I have to say I never saw that coming, I've never been hospitalized in my life before this, just overnight when I had my kids. And the week of nausea/vomiting trumps my childbirth experiences, hands down, I pray never to have to go through something like that again.

Dr. Schwab, thanks for a very helpful blog. I'm 54, in reasonably good health, but have pain centrally and in general location of gallbladder, radiating to lower back sometimes. Some pain also on left side. Morning nausea, belching, gas. Normal EGD, 2 normal ultrasounds (no stones). HIDA scan results 19% EF...scan led to more pain and nausea later in the day. Gastro recommending a surgery consult. Question: to what extent can I conclude that having GB out would rid me of the symptoms; and what questions should I be asking my Gastro and surgeon? Many thanks for sharing your experience and knowledge!

I can't say much about a specific case with which I'm not personally familiar, but in general, as you've probably read in this and the other GB posts, and in the comments, it's been my feeling that removal of the GB is successful, absent any clear evidence of stones and/or inflammation on ultrasound, is when the patient's symptoms are pretty classical for biliary colic, and when the HIDA shows definite abnormal emptying AND reproduces the symptoms at the time of the injection. Not later.

Based on the description you gave, at least two of the three criteria (my criteria: meaning they're hardly carved in stone or perfect in either direction) aren't met.

On the other hand, you've seen a GI doc, which is a prerequisite in my opinion. The question for the GI doc is if s/he feels every other explanation has been satisfactorily ruled out. Maybe whether s/he would have his/her GB out at this point, and why or why not.

You can ask the surgeon the same things. I don't know that there are any surgery-specific questions, other than generic ones. In these cases, I generally told patients it was not possible to be very predictive, but if the GI doc thinks it makes sense and if the patient wants it done knowing the outcome is uncertain, then it's reasonable to do.

This four-year old post lacks any "Medically" relevant scientific reasons WHY a GB Flush wouldn't work. All you did was call 'em quacks.Nice try, but ever since the AMA violently persecuted anyone who did not operate within their sphere of authority and hijacked all medical schools in America all you disciples have ever done is to call them quacks and crush your competition.When you free the American people from this bondage of medicine/drugs where iatrogenic deaths are about 730,000 people each year - and you start to treat a person to CURE them - instead of just getting rich (and snobby) by treating their symptoms - THEN I might listen to you.

I came here to research GB flushes and you did nothing to dissuade me. What are the dangers of it? Nothing, except that you don't get to cut someone open and let them pay you several thousand dollars.

What are the dangers (if any) of trying this 'flush'? That is why I came to your stuck-up blog. To get knowledge. You only belittled people.

Let me tell you - the proof is in the pudding. As a sonographer you know as well as I do that most stones are not calcified enough to produce echoes and therefore are candidates for expelling safely. I have my patients fast before an exam and then give them an egg to view the GB in contraction. I can SEE when a GB flush works and when it doesn't.

My patients have told me about this 'flush' and I have seen improved GB's - THEREFORE EVEN calcified stones can be dissolved and safely passed.

Its too bad the public is so brainwashed by you 'god-complexes' that they let you butcher their bodies and make them mortgage the farm to pay you.

YOU SHOW ME VALID - PEER-REVIEWED CLINICAL STUDIES SHOWING THAT A 'FLUSH' DOESN'T WORK AND I'LL SHUT-UP AND SIT DOWN.

However because of my courage to dare question you - I doubt that you will even allow this comment to be on your blog.

Thank you for your thoughtful and compelling critique. Hard to argue with such well-reasoned and thoroughly supported claims.

Other than with everything, I only have one small quibble: When you propose a bogus treatment and claim it works (cleverly throwing in that your stones don't show on ultrasound and therefore can't be followed up), and when you equate contraction with "working," by the laws of logic and reason it's up to you to produce peer-reviewed studies to prove that it does work. Then we'll talk.

Because when you think about it, if it were up to science to disprove every whack-job and unsubstantiated claim out there, journals would be pretty cluttered up, wouldn't they? Hardly have time for real research. But maybe that's your point.

I can honestly tell you that i did have gall stones I have done the flush twice and since the flush my liver enzymes which were high have came down.my thyroid meds have been cut in half and i feel the best i have ever felt in my life.i have passed hundreds of stones and let me tell you all i didn't drink enough oil and juice to produce 100's of stones.hoax or not .just saying i feel better now than i have in years.and hey i still have my gall bladder and have been eating foods that previous to the flush would have me doubled over in pain.each to their own i choose detox.

I'm glad you're doing well. I'm also certain that if you ever have it checked you'll find at least as many stones as ever in your gallbladder, and that whatever they were, those things you passed were not gallstones.

Which is not to deny that many things can make people feel better. I'm happy you found one.

I wrote to you back in November after an attack of pancreatitis and prior to removal of my gallbladder on 11-18-2011. The surgery was performed outpatient and everything was going well with my recovery until I began vomiting 5 days after the surgery. I was admitted to the hospital for 8 days before the vomiting finally resolved, I had a very small hematoma but in the end nobody was sure of the cause of the vomiting.

Everything was good until mid August when I got some sort of stomach bug, diarrhea, nausea and vomiting. I was hospitalized for 3 days for dehydration, diagnosed with gastroenteritis, but after discharge it was another 12 days before the vomiting stopped, 15 days in total, ending around the end of the first week of September.

On October 2 I began vomiting again violently and was admitted to the hospital again for 3 days. Again, dehydration, they performed an endoscopy while I was inpatient and biopsied my stomach and upper part of my small intestine. All looked good, biopsies were negative and I was feeling better by the 4th and discharged.

I had a colonoscopy scheduled for Oct. 11, the appt made back in Sep after my 15-day illness. I made it through the prep divided into 2 days, the 10th and 11th. They put me out with propofol, which they'd also used to put me to sleep for the cholecystectomy.

The moment I regained consciousness in the recovery room I threw up, really before I was fully awake. They gave me zofran, benadryl and phenergan. I spent the next four hours in recovery until they closed at 5, still vomiting. They sent me home with my husband, where I continued to vomit through the night. I waited until 5 the next day, although the vomiting had slowed a bit I was still vomiting at least every 60-90 minutes and every time I drank anything, so I went back to the hospital.

They again admitted me and ordered an abdominal MRI w and w/o contrast. Everything came back normal, I vomited through Saturday and Sunday was feeling better and they sent me home.

The GI doc called to tell me that the biopsies they took during the colonoscopy were normal and that I don't have to go back for 7 years. One of the docs in the hospital suggested cyclic vomiting syndrome.

I don't know what to do, I'm at my wit's end. I've lived in San Diego now for 30 years and until I had pancreatitis last November I've never once been to urgent care or the ER. My only hospitalizations were overnight stays when I gave birth to my sons.

I feel like the docs are giving up on me. I need help and I don't know where to turn. I've always considered myself healthy and strong, I exercise and keep active, I try to eat a good diet and I just can't bear this random vomiting which is interfering with every aspect of my life. I know the gallbladder surgery isn't necessarily the cause, but this never happened before the surgery.

Kathy, I really wish I could help. Fact is, if you'd been my patient I'd have long since referred you to a gastroenterologist, after ruling out obvious surgical issues, like mechanical obstruction, or recurrent pancreatitis (which sometimes has surgical remedies.)

I don't have answers, or even ideas, other than suggesting that you seek even more opinions, especially at a major referral center, like a teaching hospital, if there's one near you.

Thanks for the post. I had done 4 LVGB flushes. After which I got really sick and lost a ton of weight. After some testing, they found I had some lead poisoning - explaining why I was feeling so toxic. Chelation for close to 2 years got harder and harder and I had to stop. But I can still "hear" the author of the LVGB Flush book saying that if you don't finish the initial 10-12 flushes in a row, you could get worse.

So your post is timely, given you're a surgeon and have seen stones up close.

I will say this, my "curds" started off green and went to yellow in successive flushes. All were a consistency that could be flattened easy if pressed. Not sure why I didn't try. Stools would be dark for a few days and then return to a pale, tan consistency.

Anyway, what I'd love to see is the following evidence that what I saw was not stones. And I'm not sure how anyone would obtain it. It would be truly powerful. Because I wasted a lot of cycles on this thing and could have focused in other areas.

1) Could someone (ie: a surgeon) take existing stones from a gallbladder removal and subject them to a soaking in Malic Acid (apple juice) for a period of up to 7 days to see if they soften as he LVGB book's author claims? The protocol calls for 7 days of drinking apple juice constantly to "soften" the stones so they would pass through the ducts.2) What kind of lab would take the "curds" and prove that they are in fact a soap made of bile salts and olive oil - not stones that contain calcium, cholesterol, etc. If I knew where to send them, I'd send them to the lab myself and gladly post the results. Simply because the question of these has dogged me for so long. And I suspect that these cleanses may actually have made me worse.3) Is there a way to see if Epsom Salts taken in large quantity "dilate" the bile ducts to prepare them to pass stones as the author suggests. Anyway to get a camera down there and have someone swallow them?

I think if these 3 questions were debunked, then it's forever put to rest. Thanks again

Brian, those are excellent questions. (I admit I hadn't heard the epsom salts claim, and I'm willing to bet heavily that it's bogus, too. And, I'd guess, potentially dangerous if taken in high quantities.)

I know that there are labs that do stone analysis, both of kidney stones and gallstones. On those rare occasions when I've seen it done, it was via our local hospital pathology lab. Tempted as I've been, vis a vis the "curds," I've never asked that it be done, since I'd be paying for it. And, given the need of the human brain to deny reality, I'm not sure the results (about which I have zero doubt) would convince the true believers.

I'd think that if you were to call your local hospital and talk to the pathology lab, or check for local pathology labs in your area, online or otherwise, you could be directed to labs that would accept them, and find out the cost.

To confirm the bogosity of the epsom salts claim, I guess the least expensive way would be to have ultrasound images taken of your bile ducts while ingesting the stuff. However, the critical duct would the the cystic duct, ie the one between the gallbladder and the main bile duct.

Stones are mostly in the gallbladder, and it'd have to be that duct that would dilate to let them pass. It's pretty small, and harder to see on ultrasound than the main bile duct. I can think of no physiologic mechanism by which it'd happen with salts.

Other ways that might image it would be comparing HIDA scans with and without epsom salts, or, if you really want to spend some money (good luck finding a GI doc willing to do it), you'd have to have ERCP, which involves a scope in the stomach, passing into the duodenum, and injecting dye into the ducts.

As to soaking stones in malic acid: sure, it could be done. It's possible you could get stones from a pathology lab; perhaps you'd need permission from the "owner." But even if you did, the results would in no way compare to the physiology of drinking apple juice for seven days or seven years: doing so doesn't bathe gallstones in anything. In the gallbladder, stones are bathed in bile, which gets there from the liver. Nothing you eat gets into the bile ducts or gallbladder, unless you've had surgical rearrangement of the anatomy.

Which is just one more reason why the apple juice legend is pure crap.

Thank you Sid for your response. After reading your blog I did some more research, and it appears that the answers to these questions have been documented. I have come to the conclusion that the LVGB flush is in fact a hoax, and that the "good" feeling that followed was simply relaxation from all the Magnesium. If it's OK, I'll share these two links.

The first is called "Could These Be Gallstones." It includes photographs and the resulting analysis of their contents: http://surgeonsblog.blogspot.com/2008/01/flush.html

The second is from Quack Watch. I try to keep an open mind before I rake through that site. But they've backed everything in this article up well. It's well footnoted: http://www.quackwatch.org/01QuackeryRelatedTopics/flushes.html

Firstly i am really pleased to have found a site where an actual Gallbladder surgeon can answer our questions -

I am originally from London, UK but living now in Prague, CZ -so sometimes here its not so easy to get an informed answers to more detailed questions here.

so i have Gallstones which were first found out in 2008 - small at that stage - since then especially over the last year i had attacks and in October 2012 i had another ultrasound which showed that a lot of stones were now in the gallbladder

since that time i tried many things like flushes, teas, chinese tintures, dandelion tea even tried the "Fresh Vegetable and fruit juices" book by Dr Walker who writes about a man who drank 1.5 litres of beet, carrot and cucumber over a week and out came his gallstones.. that also did nothing with me.

i have found that there is an operation in china where they use laparoscopy to enter the gallbladder and remove Only the Stones using catgut to seal it up again.

last week i spoke to a gastro Dr who also did another sono-scan on me and the gallbladder is still filled up with stones - i asked him about the Chinese operation and his comments were- Even if the stones are removed he is not sure if the gallbladder will Function / Contract as it should as its been a long time (few years) filled up with stones so the gallbladder is kind of like sleeping now..so if the stones are removed and the gallbladder does not contract as it should - then the bile will fill up inside and produce stones again.

And if it does start to function as it should then:- there are 2 types of stones - inherited and Dietry stones - if its dietry stones could be helped thought food intake but inherited will come back again..

i would like to find out your thoughts about if i should even consider the chinese operation.i am 37 years old, slim/ normal shape

Peter: In general, people who form stones form stones. Methods to remove stones without removing the gallbladder have been tried and are generally unsuccessful in the long run, because the stones nearly always come back.

Removing stones directly has been tried; injecting the gallbladder with ether-like chemicals has been tried; stone-dissolving pills have been tried. They all can get rid of the stones for a while, and then the stones tend to return over time.

In general, for a young person with lots of stones and a history of attacks my advice would typically be to have the gallbladder removed.

I hope others who read this post will note your comment: I've suggested many times that people who think they're seeing stones after a flush have another ultrasound. You did, and they were still there, and more.

It's true that your gallbladder hasn't been functioning much; which means you've been living without one for a long time. Which means it's unlikely that you'd notice a difference if it were removed; other than having nor more attacks.

Dr. Schwab, I was curious percentage wise, how many people had worse complications after gallbladder removal? I did read all of your posts about gallbladders so I apologize if I missed the answer. Do the titanium clamps left inside the body ever come undone or cause other issues? I am having surgery this month. Thank you for your help and very informative blog.

Not sure what you mean by worse complications. If you mean surgical complications such as infection or bleeding or bile leak, they amount to a very small percentage of people who have surgery. Probably no more than around one percent.

As to clips: I've written about them, too. As with everything else, not everyone agrees. But, having done many thousands of operations, using clips in all sorts of situations, I'm very comfortable in saying they cause no problems.

It happens; in my opinion it's when the diagnosis was wrong, i.e. the pain was not in fact due to gallbladder issues. Most commonly, that occurs when the symptoms aren't typical and/or there aren't stones in the gallbladder, and the presumed diagnosis is "biliary dyskinesia," about which I've written, too.

In people who have pretty typical symptoms and who have documented gallstones, the chance of continuing symptoms post operatively is pretty low. I can't give you a percentage.

haha! Not often do I find one site with everything I need to know about something! However, over the 5 years this thread has been going, you have covered just about everything - and entertainingly, too! Thank you - you have saved me $$ on olive oil and epsom salts, and time spent on the toilet ;-). If this is the interest shown in such a remote, under-rated organ(the gall bladder) imagine the postings if you had studied reproductive organs! Thanks for the posting - have certainly added this blog to my favourites

What do you think it would take to do a double-blind study to learn whether this "flushing" (and other herbal and naturopathic procedures) works? Roughly how much money would it cost. One thousand dollars? Ten thousand? One hundred thousand? More? How much olive oil, grapefruits, etc, would we need to sell (or hope to sell) to accumulate the required funds?

We live in such a world of HYPE that it's not possible to Believe; we need to Know. And that can only happen after proof is obtained. The double-blind study seems to be the best way to gain proof, but people with no incentive for gain (or even reimbursement) are not likely to pay for said study.

On the brighter side, maybe a full blown and expensive study isn't necessary. I've seen the flush called a liver flush and the claim was that those greenish, softer "stones" form mainly in the liver passages (are they called sinusoids?). I guess it would be most helpful to learn once and for all if that is so, and if so, then is it possible for the main bile duct to relax or expand enough to allow a stone the size of two or three impacted garbanzo beans or whatever to pass. In fact, that bile duct bit seems to be the crux of the issue, doesn't it?

Also, on the malic acid issue, do they actually claim that drinking apple juice bathes the gb and/or liver malic acid, or do they mean that some malic acid level in the body or blood -- maybe adjacent to the "stones") will rise and thus soften them to allow them to pass. But if that was true, wouldn't the sides of the stones be smooth from being compacted in their journey through the duct,rather than having that pebbled or "mulberry" look we see in many photos? Don't those shapes appear to be formed from several smaller "stones" or pieces being impacted or conglomerated together somehow, rather than building up around something (as in a pearl, for instance)?Very odd!

Meanwhile, the fact that there is no study to prove that something is true does not prove that it is false, eh? And at any rate, you certainly have more patience than many. Keep up the good work.

I have had 3 gb attacks in 4 years. Two have been 6 months apart, most recent one this weekend. I am the typical five f's.... but as a self employed, single parent, uninsured woman, what do you suggest? I would love surgery as my mom and sister both said what a relief or was, but financially that's not an option. Suggestions please, and thank you! Leanne

About Me

I'm a mostly retired general surgeon. With my surgical blog, my intention is to inform, entertain, and possibly educate the reader about surgery, and about the life and loves of a surgeon: this one, anyway. Don't know what I'm thinking, doing a political blog, too.
In an amazing coincidence, I've also written a book, "Cutting Remarks; Insights and Recollections of a Surgeon." It's about my surgical training in San Francisco in the 1970s, aimed at the lay reader with the goal of entertaining with good stories, informing with understandable details of surgical anatomy, procedures, and diseases. Knowing you, I bet you'd enjoy it. In fact, if you like Surgeonsblog, you'll absolutely love the book!

Boring, Unoriginal, but Important Disclaimer:

What I say here is as true as I can make it, based on my experience as a surgeon. Still, in no way is it intended as specific medical advice for any condition. For that, you need to consult your own doctors, who actually know you. I hope you'll find things of interest and amusement here; maybe useful information. But please, please, PLEASE understand: this blog ought not be used in any way to provide the reader with ideas about diagnosis or treatment of any symptoms or disease. Also, as you'd expect, when I describe patients, I've changed many personal details: age, sex, occupation -- enough to make them into no one you might actually know. Thanks, and enjoy the blog.